[Experience with paraorbital-transethmoidal procedure in pituitary tumors].

In the period from 1977 to 1979, 40 transethmoidal-transphenoidal operations were carried out on 35 patients with hypophyseal adenomas. The patients were subdivided into appropriate groups and showed congruency with other statistics. The transethmoidal procedure permits the shorter anatomical way, can be combined with transnasal instruments and in particular does not involve the later and late consequences of septum operations. The transphenoidal procedure usually is considerably less onerous for the patients than the intracranial subfrontal operation. Indications for the latter are the parasellar hypophyseal tumour and second interventions after insufficient radicality of transphenoidal tumour removal. The handicap in transphenoidal interventions consists in the lacking insight into intra- and suprasellar regions. At present, the X-ray picture intensifier and the subtle intuition of the surgeon are helpful in this connection. For some patients, endocopy of the sella has already been employed. This method, however, still requires further technical improvement, so that tumour remains can also be removed by the endoscopic way. Sometimes, suprasellar tumour parts that have not been removed descend into the sella only in the course of some weeks to some months and can then be removed in a second intervention. Second interventions are also necessary when fistulas appear unless one succeeds already in the tumour operation in closing the surgical opening in the wall of the sella. When no liquorrhoea is present after the removal of the adenoma, the placing of gelatin sponge pieces will be sufficient, otherwise lyophilised dura is glued on the opening. In the postoperative phase, the rapid mobilisation and rehabilitation without any additional psychic phenomena is particularly evident.