Transsphenoidal microsurgical management of pituitary adenomas.

The transsphenoidal microsurgical operation is the best choice for most pituitary adenomas, whether or not there is an extension into the sphenoid or a supra-sellar extension without lateral spread. The advantage of this approach is that it allows selective removal of the adenoma and therefore can preserve normal pituitary function. In our series of 249 cases 79% had achieved a remission at follow-up one year or more after surgery. The surgical failure rate was 21%, and the mortality rate 0.8%. Complications occurred in 5.6%; most were temporary and minimal. The recurrence rate after transsphenoidal microsurgery was lower than that quoted in the literature after craniotomy. The smaller the size of the adenomas and the less the hormone abnormality preoperatively, the better the outcome.