Endoscopic Transsphenoidal Surgery


Tumoral pathology of the pituitary gland represents 15.3% of the primary neoplasms of the Central Nervous System (CNS). Several types of tumors affect the sellar region; among these are the pituitary carcinoma, pituitary blastoma, tumors of the neurohypophysis, neuronal and paraneuronal tumors, craniopharyngiomas, mesenchymal tumors, adenomas and others. Adenomas are the most common and can induce great morbidity for patients due to their hormonal hypersecretion, mass-effect or invasion of adjacent structures. Nevertheless, they are considered malignant only when they metastasize and not when they recur [1,2]. Prevalence of pituitary adenomas is estimated at 17% [3]. In Europe, the incidence is reported around 3 to 4 of 100,000 new cases per year with a prevalence that oscillates between 78 to 94 of 100,000 people [4]. Patients with these tumors generally have a good clinical response to surgical management, and suitable pharmacology therapy or radiotherapy. Nonetheless, a small proportion of these tumours can have unpredictable behaviour due to an aggressive pathology, and predicting the possibility of tumor progression after surgical resection is of great clinical value [5]. Size, hormonal activity, and invasion of adjacent structures can help establish a tumour’s aggressiveness and morbidity, and therefore aid in the decision making process regarding the appropriate treatment for each patient [6-8]. Morbidity usually involves clinical features or entitites secondary to compression of adjacent neurovascular structures.