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. 1997 May;76(5):398–404. doi: 10.1136/adc.76.5.398

Transsphenoidal surgery for pituitary tumours

A Massoud 1, M Powell 1, R Williams 1, P Hindmarsh 1, C Brook 1
PMCID: PMC1717180  PMID: 9196353

Abstract

Accepted 29 January 1997


OBJECTIVES—Transsphenoidal surgery (TSS) is the preferred method for the excision of pituitary microadenomas in adults. This study was carried out to establish the long term efficacy and safety of TSS in children.
STUDY DESIGN—A 14 year retrospective analysis was carried out on 23 children (16 boys and seven girls), all less than 18 years of age, who had undergone TSS at our centre.
RESULTS—Twenty nine transsphenoidal surgical procedures were carried out. The most common diagnosis was an adrenocorticotrophic hormone (ACTH) secreting adenoma (14 (61%) patients). The median length of follow up was 8.0 years (range 0.3-14.0 years). Eighteen (78%) patients were cured after the first procedure. No death was related to the operation. The most common postoperative complication was diabetes insipidus, which was transient in most patients. Other complications were headaches in two patients and cerebrospinal fluid leaks in two patients. De novo endocrine deficiencies after TSS in children were as follows: three (14%) patients developed panhypopituitarism, eight (73%) developed growth hormone insufficiency, three (14%) developed secondary hypothyroidism, and four (21%) developed gonadotrophin deficiency. Permanent ACTH deficiency occurred in five (24%) patients, though all patients received postoperative glucocorticoid treatment until dynamic pituitary tests were performed three months after TSS.
CONCLUSIONS—TSS in children is a safe and effective treatment for pituitary tumours, provided it is performed by surgeons with considerable experience and expertise. Surgical complications are minimal. Postoperative endocrine deficit is considerable, but is only permanent in a small proportion of patients.



• Transsphenoidal surgery is a safe and effective treatment for pituitary tumours in children

• Transsphenoidal surgery should be performed by surgeons with considerable experience and expertise

• Surgical complications of transsphenoidal surgery are minimal and endocrine deficit is permanent in only a small proportion of patients

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Selected References

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  1. Black P. M., Zervas N. T., Candia G. L. Incidence and management of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery. 1987 Jun;20(6):920–924. doi: 10.1227/00006123-198706000-00017. [DOI] [PubMed] [Google Scholar]
  2. Bochicchio D., Losa M., Buchfelder M. Factors influencing the immediate and late outcome of Cushing's disease treated by transsphenoidal surgery: a retrospective study by the European Cushing's Disease Survey Group. J Clin Endocrinol Metab. 1995 Nov;80(11):3114–3120. doi: 10.1210/jcem.80.11.7593411. [DOI] [PubMed] [Google Scholar]
  3. Boggan J. E., Tyrrell J. B., Wilson C. B. Transsphenoidal microsurgical management of Cushing's disease. Report of 100 cases. J Neurosurg. 1983 Aug;59(2):195–200. doi: 10.3171/jns.1983.59.2.0195. [DOI] [PubMed] [Google Scholar]
  4. Buchfelder M., Fahlbusch R. Neurosurgical treatment of Cushing's disease in children and adolescents. Acta Neurochir Suppl (Wien) 1985;35:101–105. doi: 10.1007/978-3-7091-8813-2_17. [DOI] [PubMed] [Google Scholar]
  5. Dattani M. T., Pringle P. J., Hindmarsh P. C., Brook C. G. What is a normal stimulated growth hormone concentration? J Endocrinol. 1992 Jun;133(3):447–450. doi: 10.1677/joe.0.1330447. [DOI] [PubMed] [Google Scholar]
  6. Dyer E. H., Civit T., Visot A., Delalande O., Derome P. Transsphenoidal surgery for pituitary adenomas in children. Neurosurgery. 1994 Feb;34(2):207–212. doi: 10.1227/00006123-199402000-00001. [DOI] [PubMed] [Google Scholar]
  7. Escourolle H., Abecassis J. P., Bertagna X., Guilhaume B., Pariente D., Derome P., Bonnin A., Luton J. P. Comparison of computerized tomography and magnetic resonance imaging for the examination of the pituitary gland in patients with Cushing's disease. Clin Endocrinol (Oxf) 1993 Sep;39(3):307–313. doi: 10.1111/j.1365-2265.1993.tb02370.x. [DOI] [PubMed] [Google Scholar]
  8. Hardy J. Transphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg. 1969;16:185–217. doi: 10.1093/neurosurgery/16.cn_suppl_1.185. [DOI] [PubMed] [Google Scholar]
  9. Hardy J. Transsphenoidal hypophysectomy. J Neurosurg. 1971 Apr;34(4):582–594. doi: 10.3171/jns.1971.34.4.0582. [DOI] [PubMed] [Google Scholar]
  10. Howlett T. A., Drury P. L., Perry L., Doniach I., Rees L. H., Besser G. M. Diagnosis and management of ACTH-dependent Cushing's syndrome: comparison of the features in ectopic and pituitary ACTH production. Clin Endocrinol (Oxf) 1986 Jun;24(6):699–713. doi: 10.1111/j.1365-2265.1986.tb01667.x. [DOI] [PubMed] [Google Scholar]
  11. Kane L. A., Leinung M. C., Scheithauer B. W., Bergstralh E. J., Laws E. R., Jr, Groover R. V., Kovacs K., Horvath E., Zimmerman D. Pituitary adenomas in childhood and adolescence. J Clin Endocrinol Metab. 1994 Oct;79(4):1135–1140. doi: 10.1210/jcem.79.4.7525627. [DOI] [PubMed] [Google Scholar]
  12. Lamberts S. W., van der Lely A. J., de Herder W. W. Transsphenoidal selective adenomectomy is the treatment of choice in patients with Cushing's disease. Considerations concerning preoperative medical treatment and the long-term follow-up. J Clin Endocrinol Metab. 1995 Nov;80(11):3111–3113. doi: 10.1210/jcem.80.11.7593410. [DOI] [PubMed] [Google Scholar]
  13. Leinung M. C., Kane L. A., Scheithauer B. W., Carpenter P. C., Laws E. R., Jr, Zimmerman D. Long term follow-up of transsphenoidal surgery for the treatment of Cushing's disease in childhood. J Clin Endocrinol Metab. 1995 Aug;80(8):2475–2479. doi: 10.1210/jcem.80.8.7629245. [DOI] [PubMed] [Google Scholar]
  14. Leinung M. C., Zimmerman D. Cushing's disease in children. Endocrinol Metab Clin North Am. 1994 Sep;23(3):629–639. [PubMed] [Google Scholar]
  15. Littley M. D., Shalet S. M., Beardwell C. G., Ahmed S. R., Sutton M. L. Long-term follow-up of low-dose external pituitary irradiation for Cushing's disease. Clin Endocrinol (Oxf) 1990 Oct;33(4):445–455. doi: 10.1111/j.1365-2265.1990.tb03883.x. [DOI] [PubMed] [Google Scholar]
  16. Mampalam T. J., Tyrrell J. B., Wilson C. B. Transsphenoidal microsurgery for Cushing disease. A report of 216 cases. Ann Intern Med. 1988 Sep 15;109(6):487–493. doi: 10.7326/0003-4819-109-6-487. [DOI] [PubMed] [Google Scholar]
  17. Marcovitz S., Wee R., Chan J., Hardy J. The diagnostic accuracy of preoperative CT scanning in the evaluation of pituitary ACTH-secreting adenomas. AJR Am J Roentgenol. 1987 Oct;149(4):803–806. doi: 10.2214/ajr.149.4.803. [DOI] [PubMed] [Google Scholar]
  18. Melby J. C. Therapy of Cushing disease: a consensus for pituitary microsurgery. Ann Intern Med. 1988 Sep 15;109(6):445–446. doi: 10.7326/0003-4819-109-6-445. [DOI] [PubMed] [Google Scholar]
  19. Miller D. L., Doppman J. L., Peterman S. B., Nieman L. K., Oldfield E. H., Chang R. Neurologic complications of petrosal sinus sampling. Radiology. 1992 Oct;185(1):143–147. doi: 10.1148/radiology.185.1.1523298. [DOI] [PubMed] [Google Scholar]
  20. Nichols D. A., Laws E. R., Jr, Houser O. W., Abboud C. F. Comparison of magnetic resonance imaging and computed tomography in the preoperative evaluation of pituitary adenomas. Neurosurgery. 1988 Feb;22(2):380–385. doi: 10.1227/00006123-198802000-00018. [DOI] [PubMed] [Google Scholar]
  21. Oldfield E. H., Chrousos G. P., Schulte H. M., Schaaf M., McKeever P. E., Krudy A. G., Cutler G. B., Jr, Loriaux D. L., Doppman J. L. Preoperative lateralization of ACTH-secreting pituitary microadenomas by bilateral and simultaneous inferior petrosal venous sinus sampling. N Engl J Med. 1985 Jan 10;312(2):100–103. doi: 10.1056/NEJM198501103120207. [DOI] [PubMed] [Google Scholar]
  22. Oldfield E. H., Doppman J. L., Nieman L. K., Chrousos G. P., Miller D. L., Katz D. A., Cutler G. B., Jr, Loriaux D. L. Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing's syndrome. N Engl J Med. 1991 Sep 26;325(13):897–905. doi: 10.1056/NEJM199109263251301. [DOI] [PubMed] [Google Scholar]
  23. Partington M. D., Davis D. H., Laws E. R., Jr, Scheithauer B. W. Pituitary adenomas in childhood and adolescence. Results of transsphenoidal surgery. J Neurosurg. 1994 Feb;80(2):209–216. doi: 10.3171/jns.1994.80.2.0209. [DOI] [PubMed] [Google Scholar]
  24. Salassa R. M., Laws E. R., Jr, Carpenter P. C., Northcutt R. C. Transsphenoidal removal of pituitary microadenoma in Cushing's disease. Mayo Clin Proc. 1978 Jan;53(1):24–28. [PubMed] [Google Scholar]
  25. Schulte H. M., Allolio B., Günther R. W., Benker G., Windeck R., Winkelmann W., Reinwein D. Bilateral and simultaneous sinus petrosus inferior catheterization in patients with Cushing's syndrome: plasma-immunoreactive-ACTH-concentrations before and after administration of CRF. Horm Metab Res Suppl. 1987;16:66–67. [PubMed] [Google Scholar]
  26. Snow R. B., Patterson R. H., Jr, Horwith M., Saint Louis L., Fraser R. A. Usefulness of preoperative inferior petrosal vein sampling in Cushing's disease. Surg Neurol. 1988 Jan;29(1):17–21. doi: 10.1016/0090-3019(88)90117-6. [DOI] [PubMed] [Google Scholar]
  27. Symon L., Logue V., Mohanty S. Recurrence of pituitary adenomas after transcranial operation. J Neurol Neurosurg Psychiatry. 1982 Sep;45(9):780–785. doi: 10.1136/jnnp.45.9.780. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Tagliaferri M., Berselli M. E., Loli P. Transsphenoidal microsurgery for Cushing's disease. Acta Endocrinol (Copenh) 1986 Sep;113(1):5–11. doi: 10.1530/acta.0.1130005. [DOI] [PubMed] [Google Scholar]
  29. Trainer P. J., Grossman A. The diagnosis and differential diagnosis of Cushing's syndrome. Clin Endocrinol (Oxf) 1991 Apr;34(4):317–330. doi: 10.1111/j.1365-2265.1991.tb03773.x. [DOI] [PubMed] [Google Scholar]
  30. Trainer P. J., Lawrie H. S., Verhelst J., Howlett T. A., Lowe D. G., Grossman A. B., Savage M. O., Afshar F., Besser G. M. Transsphenoidal resection in Cushing's disease: undetectable serum cortisol as the definition of successful treatment. Clin Endocrinol (Oxf) 1993 Jan;38(1):73–78. doi: 10.1111/j.1365-2265.1993.tb00975.x. [DOI] [PubMed] [Google Scholar]
  31. Tyrrell J. B., Brooks R. M., Fitzgerald P. A., Cofoid P. B., Forsham P. H., Wilson C. B. Cushing's disease. Selective trans-sphenoidal resection of pituitary microadenomas. N Engl J Med. 1978 Apr 6;298(14):753–758. doi: 10.1056/NEJM197804062981401. [DOI] [PubMed] [Google Scholar]
  32. Weber A., Trainer P. J., Grossman A. B., Afshar F., Medbak S., Perry L. A., Plowman P. N., Rees L. H., Besser G. M., Savage M. O. Investigation, management and therapeutic outcome in 12 cases of childhood and adolescent Cushing's syndrome. Clin Endocrinol (Oxf) 1995 Jul;43(1):19–28. doi: 10.1111/j.1365-2265.1995.tb01888.x. [DOI] [PubMed] [Google Scholar]
  33. Welbourn R. B. The evolution of transsphenoidal pituitary microsurgery. Surgery. 1986 Dec;100(6):1185–1190. [PubMed] [Google Scholar]
  34. Williams R. A., Jacobs H. S., Kurtz A. B., Millar J. G., Oakley N. W., Spathis G. S., Sulway M. J., Nabano J. D. The treatment of acromegaly with special reference to trans-sphenoidal hypophysectomy. Q J Med. 1975 Jan;44(173):79–98. [PubMed] [Google Scholar]
  35. Wilson C. B., Dempsey L. C. Transsphenoidal microsurgical removal of 250 pituitary adenomas. J Neurosurg. 1978 Jan;48(1):13–22. doi: 10.3171/jns.1978.48.1.0013. [DOI] [PubMed] [Google Scholar]

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