Pituitary adenoma

The annual incidence of pituitary adenomas varies from 2 to 7 cases per 100,000 person/year. They represent 10-15% of all intracranial tumors. They are more common in women, and between the third and sixth decades of life.

Most pituitary adenomas are usually benign and have a low level of growth. In general, small adenomas are confined to the sella, although it is not uncommon to find these small and medium-sized tumors infiltrating the cavernous sinus. On the other hand, we?ve got the invasive adenomas with a more aggressive course and a fast growing tendency invading structures like the carotid arteries or the optic nerves (Figure 1).

Pituitary adenomas may manifest as compression of adjacent structures as the optic nerves (progressive loss of vision) or by injuring one’s own pituitary (hormone deficiency: reduced sexual libido or impotence). Other manifestations are due to increased hormone production leading to diseases such as acromegaly or Cushing’s disease.

The first line treatment for pituitary tumors is surgery with the exception of prolactinomas whose treatment is medical. In this last case, surgery is reserved when there is no response to medical treatment, tumors with visual impairment or patients who can not tolerate the side effects of treatment. It is known that pituitary surgery outcomes are directly related to the neurosurgeon’s experience and training devoted to this field. By consensus, it is considered that a pituitary neurosurgeon should be performed at least 100 pituitary surgeries, and then complete a minimum of 25 interventions per year.

Our group is leader in the use of endoscopic techniques for the treatment of these tumors, having done more than 150 endoscopic procedures (Video Clip 1).

In Figure 2, Figure 3 y Figure 4 explains the surgical technique.