Transsphenoidal microsurgery of pituitary macroadenomas with long-term follow-up results

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  • 1 Department of Surgery, Division of Neurosurgery, Department of Radiology, Division of Neuroradiology, Department of Surgery, Division of Ophthalmology, and Department of Radiation Medicine, Evanston Hospital, Northwestern University Medical School, Evanston, Illinois
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✓ The authors have reported on 108 patients with pituitary macroadenomas (measuring 2 cm in at least one diameter) who underwent 117 transsphenoidal operations and five craniotomies, and were followed for periods ranging from 6 months to 14 years. Vision improved in 90% of the patients. Gross total tumor removal with no evidence of residual tumor tissue demonstrable on the postoperative computerized tomography scan was accomplished in 41% of cases. However, gross total tumor removal is not synonymous with complete tumor removal. Endocrine cure was possible in 25% of prolactin-secreting and 20% of growth hormone-secreting adenomas. The incidence of recurrence was 12%, with the majority occurring from 4 to 8 years postoperatively. Both the tumors with suprasellar extension of more than 2 cm and the hard fibrotic tumors had a higher recurrence rate. Postoperative administration of radiation therapy has been associated with a significantly lower recurrence rate than when this therapy was withheld. Transsphenoidal surgery of pituitary macroadenomas confined to the extra-arachnoid space is associated with a relatively small number of complications. The operative technique used in this series is described.

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Contributor Notes

Address reprint requests to: Ivan Ciric, M.D., North Shore Neurosurgeons, S.C., 2500 Ridge Avenue, Evanston, Illinois 60201.
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