Transcranial Surgery of Giant Pituitary Adenomas

V.E. Olyushin, A.Yu. Ulitin

(Polenov Research Neurosurgical Institute, Saint Petersburg)

Pituitary adenomas account for 10-15% of all primary cerebral tumors. According to autopsy data, they are watched in 20% of cases. The last decades are characterized by considerable achievements in treatment of pituitary adenomas. It is explained by development of transsphenoidal surgery (this approach is used in removal of more than 80% of adenomas) and widening possibilities of drug therapy. At the same time transcranial approaches have not lost their importance in surgery of pituitary adenomas. It concerns giant adenomas with marked invasive growth into frontal lobes and the skull base bones and their spread into the third and lateral ventricles, cavernous sinus, middle cranial fossa, orbit. Tumors with multiple nodes, anatomic peculiarities of location of internal carotid arteries are indications for transcranial approaches. There are relative contraindications for transsphenoidal surgery. They include the narrow saddle, airless sphenoid sinus and inflammatory diseases of nasal sinuses.

We would like to illustrate potentialities of transcranial surgery of giant pituitary adenomas on the basis of our experience (more than 300 cases, treated since 1986).