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Neuroradiology

Transphenoidal hypophysectomy

neurosurgical technique to remove pituitary tumours, which has widely replaced the original procedure of craniotomy.

It is currently preferred for the surgical management of the vast majority of pituitary tumours. Indications for this approach include microadenomas, intrasellar craniopharyngiomas, hypophysectomy, tumour extension into the sphenoid sinus, tumours associated with CSF rhinorrhoea, excessive risk, due to the patient's condition, for a transcranial approach. Chordomas, pituitary abscesses, mucoceles and cysts may also be approached transphenoidally. Contraindications are represented by significant extension of tumour subfrontally, retrochiasmatically or into the middle fossa.

The approach is sublabial, under the nasal mucosa, and then transphenoidally through the dura of the floor of the sella.

Radiologically, the approach is planned first on the basis of CT and MR study. The evaluation of pneumatization of the sphenoid air cells is important as well as the position of the intersphenoid septum. During surgery the neurosurgeon verifies the correct position by fluoroscopy.

GS