Management Of Sellar And Parasellar Lesions: A Retrospective Analysis: A Retrospective Clinical Study

摘要

Background: The sellar and parasellar region is an anatomically complex area with pathology in this area accounts for distinctive neurological syndromes characterized by visual failure and upper cranial neuropathies. The majority of neoplasms arising in the sella turcica are pituitary adenomas followed by craniopharyngiomas, germ cell tumors, meningiomas, chordomas, gliomas, and Schwannomas. The treatment is basically surgical and the choice of the surgical approaches is first determined by the surgeon own preference and experience, secondly by the site and direction of the growth.Objective: The aim of this study is to evaluate the incidence of various lesions in the sellar and parasellar area and the different protocols for management of these lesions.Patients and Methods: This study included 50 cases of sellar and parasellar mass lesions that were admitted and treated in the Neurosurgical Department, Ain Shams University Hospitals, and Dar El Shefa hospital between 2014 and 2017. The patients' data, preoperative, post-operative, complications, approaches, and surgical results were collected and analyzed retrospectively for results.Results: 27 cases were pituitary adenomas (54%), 6 cases craniopharyngiomas (12%), 11 cases meningiomas (22%), 2 cases astrocytomas (4%), one case Pituicytoma (2%), one case Lipoma representing (2%), one case was suprasellar abscess (2%) and one case was Rathke's cleft cyst (2%). Diminution of vision was present in 35 cases (70%). Total radical resection had been accomplished in 27 cases (54%), subtotal (nearly total) excision in 19 cases (38%) and partial excision in four cases (8%).Conclusion: The most common lesions encountered in this series were pituitary adenomas representing (54%) followed by meningiomas, representing (22%) of cases. The main symptoms and signs were increased intracranial tension (headache and blurring) followed by visual symptoms and endocrinal disturbances. The choice of surgical approach was determined by the lesion site and the direction of growth. Microscopic transsphenoidal approach was suitable for most pituitary adenomas done in 22 cases (44%). Diabetes insipidus was the most common postoperative endocrinal disturbances.