The transsphenoidal removal of nonfunctioning XXXX with suprasellar extensions: the open sella method and intentionally staged operation.

@entity5 @entity1 @entity652 @entity977
The surgical treatment of large @entity977 with suprasellar extensions has been controversial. To elucidate the indications for transsphenoidal surgery of large @entity652 and to evaluate the techniques for removing the suprasellar portions of the @entity5 , surgical procedures on 100 consecutive @entity1 with suprasellar extensions of nonfunctioning @entity977 were retrospectively investigated. @entity1 were followed up for 1 to 12 years (mean, 4.5 yr). One hundred twenty-five transsphenoidal operations were performed on 100 @entity1 . The removal of each suprasellar @entity5 was facilitated by the placement of a lumbar subarachnoid catheter and the injection of lactated Ringer's solution or saline. This method was used in 77 operations and was effective on 60 of 72 @entity652 with < 30-mm suprasellar extensions (Hardy's Grades A, B, and C) but not on those that were fibrous or dumbbell-shaped. The descent of the remaining suprasellar @entity5 was facilitated by keeping the sella and sellar floor open with an intrasellar drain, and the subsequent removal was achieved with staged transsphenoidal operations. Of nine fibrous or dumbbell-shaped @entity652 with 10- to 30-mm suprasellar extensions, gross total removal in eight was achieved by the open sella technique and two-stage transsphenoidal operation, whereas one required transcranial surgery. @entity652 with > 30-mm suprasellar or lateral extensions (Grade D) could not be removed sufficiently by transsphenoidal operations, except one @entity652 for which a subtotal removal was achieved in the third staged operation. The disease-free rate 10 years after operation was 74% for all @entity1 : 91% for Grade A, 74% for Grade B, and 61% for Grade C.(ABSTRACT TRUNCATED AT 250 WORDS)
