Transsphenoidal Microsurgery of Pituitary Adenoma.

Lee, Sang Hyung; Lee, Sung Hoon; Jung, Hee Won; Kim, Hyun Jib; Han, Dae Hee; Sim, Bo Sung; Choi, Kil Soo; Min, Yang Kee; Min, Hyun Kee

Original Article

Journal of Korean Neurosurgical Society 1988;17(2): 221-236.

Sang Hyung Lee, Sung Hoon Lee, Hee Won Jung, Hyun Jib Kim, Dae Hee Han, Bo Sung Sim, Kil Soo Choi, Yang Kee Min, Hyun Kee Min

¹Department of Neurosurgery, College of Medicine, Seoul National University, Seoul, Korea.
²Department of Otolaryngology, College of Medicine, Seoul National University, Seoul, Korea.
³Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea.

ABSTRACT

Anthor reviewed the 102 cases of pituitary adnomas treated via transsphenoidal adenomectomy from August 1977 to July 1987, at the Seoul National University Hospital. The results obtained were as follows: 1) Male to female ratio of pituitary adenoma treated by TSA was 1:1.6. 2) Seventy-five cases(74%) of pituitary adenomas were functioning(endocrine-active) adenomas and twenty-seven cases(26%) were nonfunctioning endocrine-inactive). Functioning adenomas were composed of prolactin-secreting adenoma(47%), GH-secreting adenoma(25%) and ACTH-secrting adenoma(6%). 3) According to radiologic classification, intrapituitary adenoma(Grade I) was 4%, intrasellar adenoma(Grade II) 54%, diffuse adenoma(Grade III) 30% & invasive adenoma(Grade IV) 12%. 4) There was a significant relationship between prolactin value and size of prolactin-secreting adenoma, but no significant relationship was found between h-GH value and size of GH-secreting adenoma. 5) In prolactin-secreting adenoma, microsurgical removal of the tumor followed by bromocriptine administration was the most effective treatment modality. 6) In GH-secrting adenoma, decrease of fasting h-GH value was obtained more effectively in cases who under went surgery plus radiation therapy than in cases with surgery alone. 7) In prolactin-secreting adenoma and GH-secreting adenoma, there was no relationship between degree of decrease in hormone values after TSA and size of the adenoma. 8) Improvement in isual acuity and visual field defect after TSA was obtained in 32% of all pituitary adenomas. There was no operative mortality and complications after TSA were accompanied in 40% of all cases, majority of which were a transient diabetes insipidus.

Key Words: Transsphenoidal approach; Prolactin-secreting adenoma; GH-secreting adenoma; ACTH-secrting adenoma; Radiation therapy; Bromocriptine