큰 뇌하수체 선종의 경접형동 접근법의 치료 경험

Clinical Experience of Large Pituitary Adenomas Treated by Transsphenoidal Approach

Objective The purpose of this study is to determine the feasibility of transsphenoidal approach (TSA) and staged or repeated TSA for large pituitary adenoma (LPA) and remnant or recurrent PA. Methods Eighteen LPAs underwent TSA surgery from February 2002 to December 2006. Eleven cases were non-functioning adenomas, 5 cases were growth hormone secreting adenomas and 2 cases were pituitary apoplexy. Mean size of tumor was 38x28x30mm. All patients were initially operated via TSA. Results Total removal was performed in 8 patients (44.4%). Subtotal removal was done in 8 patients (44.4%) by the initial TSA, two patients in which underwent repeated TSA due to postoperative tumor bleeding. The visual and hormonal symptoms were improved in 13 patients (72.2%) after the surgery. Six patients out of 8 with subtotal removal underwent the staged operation. Two patients with tumor recurrence underwent repeated TSA, 18 and 26 months respectively after the initial TSA. All patients with growth hormone-secreting PA achieved the normalization of growth hormone. Conclusion The staged and repeated TSA is one of the feasible option for the treatment of LPA and residual or recurrent PA with acceptable surgical morbidity and mortality.