Complete (radical) surgical resection of the tumor is associated with a more favorable outcome2,5.
Only 50-80% of patients are suitable for attempted complete resection.
In general, smaller tumors could be completed resected without injury to adjacent structures.
Surgical treatment is used for diagnosis, decompression and prevention of recurrence4.
Surgical technique is dependent on anatomic location and consistency of the tumor4,5,6,17
| Surgical Technique | Indications |
| Bifrontal and subfrontal approach | Supraseller tumors (prechiasmatic and large retrochiasmatic lesions) |
| Trans-sphenoidal approach | Cystic infradiaphragmatic lesions
Symmetrical and well-defined suprasellar and retrosellar lesions with enlarged sella
Tumors without calcification
Lowers surgical morbidity and postoperative visual loss |
| Stereotactic aspiration of cyst | Cystic tumors |
After complete resection there is still a chance of recurrence.
- Residual calcification and tumor is present in 15-20% of all “totally resected” cases.
- Clinical recurrence occurs in 10-30% of cases after "complete resection".
Aggressive surgical resection is associated with an increased risk of complications4,6,7:
- Neuroendocrine deficits are very common.
- Visual deficits and hypothalamic damage are less frequent with modern surgical techniques.
- One of the most common post-operative sequelae (50-80% of cases), is diabetes insipidus. This can be difficult to manage in long-term survivors.
- Morbid hypothalamic obesity may occur in 50% of cases.
- Fusiform dilation of the internal carotid artery has been known to occur in 15% of cases.
Frequency of some post-operative sequelae2,6,7:
Residual calcification or tumor after resection |
15-20% |
Clinical recurrence |
10-30% |
Diabetes insipidus |
50-80% |
| Panhypopituitarism | 75-100% |
| Neuropsychologic and behavioural disturbances | 36-60% |
Morbid hypothalamic obesity |
50% |
| Visual deterioration | 5-10% |
Fusiform dilation of internal carotid artery |
15% |
