The author reported 37 cases of pituitary adenoma operated in Department of Neurosurgery, Cho Ray hospital during the period of 30 months. Pitutary adenomas occupated 5.4% of all intracranial tumors. They occurred equally in both male and female and dominated at 30-40 of the age. The most common symptoms was visual disturbance with 57.1% had atrophy of optic nerve and endocrinological disturbance with amenorrhea (7 cases), acromegaly (4 cases), diabetes and galatorrhea. Endocrinological investigation indicated that the hyperprolactinaemia is a main disturbance (14 cases). Treatment results were not so good with 13.5% of bad results and dead. The author also discussed about the classification of pituitary function and the role of modern diagnostic equipments allowing earlier diagnosis. The surgical treatment was simple with the mainly applying of transcranial approach.
Pituitary Neoplasms ; Surgery ; therapeutics

To report the efficacy and safety of transsphenidal approach in a series of patients with pituitary adenoma, ninety-one consecutive patients undergoing transsphenoidal surgery of a pituitary adenoma at neurosurgical department, Cho Ray Hospital from January 2001 to June 2003 were included in this study. Postoperative results were analyzed. Total removal rate was 24.2% and partial removal rate was 7.7%. There were 4 patients had rhenorrhea and meningitis. Two patients died because of surgery. Normalization of visual defect was good. Transsphenoidal surgery is an effective and safe treatment for most patients with pituitary adenoma and could be considered the first choice therapy in most of the cases. Sublabial transseptal approach is suitable for our conditions.
Pituitary Neoplasms ; Surgery ; Therapeutics

Adenoma ; surgery ; Endoscopy ; Humans ; Pituitary Neoplasms ; surgery

BACKGROUNDPituitary adenomas are common intracranial tumors, with a rising incidence in China. Excision is a mainstay therapy for this disease, and is often carried out via transfrontal, transsphenoidal or transpterional approaches. However, few studies have systematically addressed the regional anatomy involved in these microsurgical procedures. The present study attempted to establish some key anatomic measurements relevant to pituitary adenoma resection based on cadaver and computer tomography (CT) image studies.

METHODSHead specimens from 30 randomly selected formalin-fixed adult cadavers were used for anatomical analysis. Measurements were made on the base of the skull following removal of brain structures above the pituitary gland, and on the mid-sagittal plane of the cranium. Parameters were designed by considering the 3 above-mentioned common microsurgical approaches, and obtained on each head using a sliding caliper. Multi-level CT images from 30 individuals were also used for distance measurements between landmark structures that are relevant to these surgeries. All data were subjected to statistical analysis using the SPSS 11.5 software.

RESULTSThere was statistically significant difference (P < 0.05) of distance measured on cadavers relative to CT images in 3 sets of measurements related to the transfrontal surgical approach, i.e., distances from the midpoint of superciliary arch superior border to the cranial entrance of internal carotid arteries (ICAs), the opposite side entrance of ICA and to the genu of ICA. While regional anatomical analyses were carried out according to the transpterional approach, statistically significant difference was also found in 3 sets of distance measurements between cadaver and CT image data, with regard to the distances between the pterion and some landmark structures around the pituitary.

CONCLUSIONSThe present study provides key anatomical and CT image measurements involving the 3 conventionally used surgical approaches for pituitary tumor resection. The data implicate that while CT scan results can provide valuable guidelines for operations, cautions and adjustments are needed during surgery for sufficient tumor excision and protection of key blood vessels and nerves in the vicinity of the pituitary gland and around the surgical pathway.

Adult ; Female ; Humans ; Male ; Pituitary Gland ; anatomy & histology ; diagnostic imaging ; Pituitary Neoplasms ; diagnostic imaging ; surgery ; Radiography

OBJECTIVETo explore factors influencing the recurrence of patients with Cushing's disease after transsphenoidal surgery.

METHODSWe retrospectively analyzed the clinical data of 182 patients treated by transsphenoidal surgery with Cushing's disease in our department in PUMC Hospital from 1992 to 2002.

RESULTSThe recurrence rates were significantly different when patients had different radiological findings (P = 0.001), operative methods (P = 0.001), histological findings (P = 0.04), and postoperative cortisol levels (P = 0.02); however, such difference was not found in term of tumor size (P = 0.43).

CONCLUSIONRadiological findings, operative methods, histological findings, and postoperative cortisol estimates may be the factors influencing the recurrence of patients treated by transsphenoidal surgery.

Adenoma ; complications ; surgery ; Female ; Humans ; Hypophysectomy ; methods ; Male ; Pituitary ACTH Hypersecretion ; etiology ; surgery ; Pituitary Neoplasms ; complications ; surgery ; Recurrence ; Retrospective Studies

OBJECTIVE: To improve the surgical outcome of pituitary adenomas by identifying and preserving the pituitary stalk and the gland during surgery. METHODS: From October 2010 to September 2012, the author from the Department of Neurosurgery of Xiangya Hospital, Central South University operated on 51 patients with pituitary adenoma. During the operations, we carefully identified the normal adenohypophysis, pituitary stalk, neurohypophysis and the abnormal tissues either by direct observation or by medical images, aiming to excise the tumor thoroughly, protect the pituitary function and reduce the postoperative complications. RESULTS: Totally 37 patients (72.5%, 37/51) had total resection of the tumor, 12 (23.5%, 12/51) had subtotal tumor resection and the other 2 had major removal. The gland and the pituitary stalk were well identified and reserved. Detection of hormone content proved that the operation had little effect on the free triiodothyronine (FT3) and adrenocorticotropic hormone (ACTH), while for free tetraiodothyronine (FT4) and thyroid stimulating hormone (TSH) and postoperative followup significant alleviation was found. There was no significant fluctuation for the testosterone in the men preoperatively and postoperatively (all the above results were obtained without hormone replacement therapy). The main postoperative complications were as follows: temporary diabetes insipidus in 5 patients (9.8%, 5/51); electrolyte disorder (the appearance of hyponatremia) in 17 (33.3%, 17/51); and cerebrospinal fluid rhinorrhea and postoperative intracranial infection in 1 (2%, 1/51). No one died during the perioperation period. CONCLUSION Microscopic transsphenoidal surgery is effective for pituitary adenomas including tumors violating the cavernous sinus. Accurate identification of the pituitary stalk, the gland and the abnormal tissue during the microscopic transsphenoidal operation plays a critical role in preserving the pituitary function and promoting postoperative rehabilitation.
Adenoma ; surgery ; Humans ; Male ; Microsurgery ; Neurosurgical Procedures ; methods ; Pituitary Gland ; surgery ; Pituitary Hormones ; blood ; Pituitary Neoplasms ; surgery ; Postoperative Complications ; Treatment Outcome

Craniopharyngioma ; surgery ; Endoscopy ; Female ; Humans ; Middle Aged ; Pituitary Neoplasms ; surgery ; Skull Base ; Sphenoid Sinus ; surgery

Pituitary apoplexy is a rare but potentially life-threatening clinical syndrome caused by the sudden enlargement of a pituitary adenoma secondary to hemorrhage or infarction. Pituitary apoplexy after cardiac surgery is a very rare perioperative complication. Factors associated with open heart surgery that may lead to pituitary apoplexy include hemodynamic instability during cardiopulmonary bypass and systemic heparinization. We report a case of pituitary apoplexy after mitral valvuloplasty with cardiopulmonary bypass. After early pituitary tumor resection and hormonal replacement therapy, the patient made a full recovery.
Cardiopulmonary Bypass ; Hemodynamics ; Hemorrhage ; Heparin ; Humans ; Infarction ; Mitral Valve Insufficiency ; Pituitary Apoplexy* ; Pituitary Neoplasms ; Postoperative Complications ; Thoracic Surgery

Hemangioblastoma (HBL) in the pituitary stalk is extremely rare. Only 16 such cases have been reported in the past and 5 cases have been treated with surgical procedure. Here, we report surgical case of HBL in the pituitary stalk diagnosed in a 34-year-old woman. The patient underwent a gross-total resection via the modified lateral supra-orbital approach. No recurrence was observed in two years after surgery. To our knowledge, this is the 17th case of HBL in the pituitary stalk and the 6th surgical case. If the tumor is symptomatic and the volume is over 5 cubic centimeters as in our case, we recommend that the surgical resection of the HBL in the pituitary stalk is a more safe and reasonable than radiotherapy.
Adult ; Cerebellar Neoplasms/pathology/*surgery ; Female ; Hemangioblastoma/pathology/*surgery ; Humans ; Pituitary Gland/*pathology ; Treatment Outcome

The application of transsphenoidal microsurgery in the management of pituitary microadenoma, long regarded as effective surgical treatment, has had a relatively low mortality and morbidity rate. However early failure and late recurrence has been reported in no small numbers. It has been proposed that stereotactic radiosurgery is an alternative treatment modality. Recent advances in neuroimaging permits precise targeting in radiosurgery of microadenomas. Additionally, a prompt hormonal reduction after the treatment is important for the patients with hormonally active microadenomas. The authors performed Gamma Knife radiosurgery in 27 patients with pituitary adenomas and observed the hormonal changes after radiosurgery in 19 patients with functioning microadenomas (5 with Cushing's disease, 7 with acromegaly, and 7 with prolactinoma). The maximum dose administered ranged from 25 to 75 Gy. The margin of the tumor was encompassed within the 50 to 90% isodose volume. The endocrinological status was assessed pre- and post-operatively. We measured the serum growth hormone and prolactin level, as well as the 24-hour urinary free-cortisol level. Normalization of the hormonal level was achieved in 6 cases, the majority of them within 10 months. The other 6 cases showed marked reduction of hormonal levels (less than 50% of preoperative levels) with a strong possibility of hormonal remission at further follow-up. The remaining 6 were failures. The cure for one case is still pending. It took approximately 1 approximately 3 months after the radiosurgery before the reduction of hormonal secretion began to show up with some improvement of symptoms. When the GKS was successful, hormonal secretion seemed to return to normal within 10 months. Although further follow-up is necessary to evaluate the long-term tumor control rate and hormonal effect, these initial results indicate a potential therapeutic role of radiosurgery in controlling hormone hypersecretion in pituitary microadenomas. Gamma knife radiosurgery is very promising in managing pituitary microadenoma with complementary of the transsphenoidal surgery.
Adenoma/metabolism/*surgery ; Adolescent ; Adult ; Female ; Human ; Male ; Middle Age ; Pituitary Neoplasms/metabolism/*surgery ; *Radiosurgery