Surgical Indications and Treatment Strategy for Pituitary Adenoma

Abstract

  Transnasal surgery for pituitary adenoma has become much more effective since the introduction of endoscopy. Endoscopic surgery facilitates wider removal of skull base bone and improves surgical freedom. Endoscopy can provide visual confirmation of the boundary between the pituitary adenoma capsule and the surrounding tissues, thus enabling extracapsular removal, which is widely used at present. Although improvement of visual function is the main goal of treatment for nonfunctioning adenomas, large multilobular pituitary adenomas carry particularly high risks for surgery, necessitating further improvements in treatment strategies. On the other hand, endocrinological cure is the main goal of treatment for functional adenomas. Expertise in medical therapy, including cooperation with endocrinologists and radiation oncologists, is also essential for successful treatment of these tumors. Surgical indications and treatment strategies should be based on adequate knowledge and experience with endonasal surgical methods and endocrinology.