Surgery of Pituitary Neoplasms:

Endovideomonitoring in Transsphenoidal Surgery of Pituitary Neoplasms

V.Yu. Cherebillo, V.R. Gofman, A.V. Polezhaev, V.A. Manukovsky

Chair of Neurosurgery, Medicomilitary Academy, Saint Petersburg, Russia

Indications for Surgical Treatment of PituitaryAdenomas

There are absolute and particular indications for surgical treatment of different pituitary adenomas.

Absolute indications are irrespective of a degree, to which hormonal activity of tumors is marked, and include:

1. Vision acuity reduction and narrowing of visual field margins, caused by an extrasellar growth of tumor and compression of the chiasm and optic nerves.

2. An impaired function of oculomotor nerves, caused by a parasellar growth of tumor.

3. Impaired liquor discharge, hydrocephalus and intracranial hypertension, caused by impression of tumor into the 3rd ventricle fundus.

4. Hemorrhage into a tumor.

5. Nasal liquorrhea, caused by destruction of the saddle fundus and its diaphragm by tumor.

6. A prolonged growth of tumor in spite of conservative treatment, including radiation therapy.

Particular indications are dependent on clinical manifestations of secreting pituitary adenomas; they are as follows:

1. For corticotroph adenoma:
   А. Cushing's disease irrespective of a tumor size.
   B. Nelson's syndrome irrespective of a tumor size.

2. For somatotroph adenoma - acromegaly (as an operation of choice or the first stage; ineffective radiation therapy).

3. For prolactinoma - ineffective therapy with bromcriptine or other drugs of this group against a background of:
   - marked impotency
   - infertility (in desired pregnancy)
   - insensibility or intolerance to drugs of the bromcriptine group.

4. For thyrotroph adenoma - progressive thyrotoxicosis (in ineffective conservative treatment).

5. For gonadotroph adenoma - marked impotency or infertility (in desired pregnancy).

An Approach Choice

In our opinion, there are only three absolute indications for choosing a transcranial approach:

• A marked parasellar growth with invasion into a cavernous sinus.

• A marked supraretroantesellar growth with spread into the third and lateral ventricles.

• Presence of a narrow intersection between suprasellar and infrasellar neoplastic nodes.

A transsphenoidal access should be an approach of choice in all the rest cases.

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