Staged Transsphenoidal Surgery for Fibrous Nonfunctioning Pituitary Adenomas with Suprasellar Extension

Staged transsphenoidal surgery was performed in seven patients with nonfunctioning pituitary adenomas with suprasellar extension. Remnant adenomas were present in a suprasellar position after complete removal of the intrasellar tumor, and did not descend into the sella because of the fibrous nature in five patients or fibrous nature and dumbbell shape in two. Magnetic resonance images were obtained every 2 weeks following initial surgery. The suprasellar residual adenomas descended into the sella within 2 months in six patients and 1.5 months in one patient. A second transsphenoidal operation was performed 2 months following the initial procedure in four patients, 3 months in one, and 5 months in two. In six of the seven patients, extensive tumor removal was achieved safely and easily by the staged approach. Patients were followed up over 6 to 58 months (mean ± SD 24.7 ± 18.9 months). There were no major surgical complications or recurrence of tumor on follow-up images. Our postoperative imaging studies and surgical results demonstrated that staged transsphenoidal surgery is an effective and safe treatment for fibrous nonfunctioning pituitary adenomas with suprasellar extension.