NeoplasmManagement of nonfunctioning pituitary adenomas with suprasellar extensions by transsphenoidal microsurgery
Section snippets
Patients and methods
From July 1982 to July 1997, we operated on 536 patients for pituitary adenomas by the transsphenoidal approach. A total of 208 patients had NPASE—soft adenomas in 196 cases and hard fibrous or dumbbell-shaped adenomas in 12 cases. Recurrence after transsphenoidal microsurgery occurred in seven patients; five of these had undergone radiotherapy. There were 98 males (47.1%) and 110 females (52.9%) aged from 16 to 71 (mean 47.5). Fifty-six patients (26.9%) were aged between 16 and 30 years, and
Results
In this series, total removal was achieved in 146 patients (70.2%), which included 137 Grades A and B, and 9 Grades C and D (Fig. 2). Subtotal removal was achieved in 50 patients (24.0%), which included 17 Grades A and B, 26 Grade C, and 7 Grade D. Partial removal was done in the remaining 12 patients including 3 Grade C and 9 Grade D (5.8%), because the tumors were dumbbell-shaped or fibrous and it was difficult to remove the suprasellar portion of the tumour via the transsphenoidal approach.
Discussion
NPASE are difficult to diagnose in the early stage because of the lack of endocrine symptoms. Only when the tumor mass is large enough to extend beyond the sella turcica and result in visual field defect or loss of visual acuity does the patient seek treatment [4]. The diagnosis of NPASE can be suspected according to the clinical manifestations and can be confirmed by radiological evidence of a mass in the sellar region and its boundaries, and abnormalities of the parasellar and suprasellar
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