The staged use of transcranial and transphenoidal surgical approaches in treating hypophyseal adenomas

: The study included 138 patients operated on for endo-extracellular pituitary adenomas which extend both intracranially and into the structures of the base of the skull. Operations via transcranial and transsphenoidal access to various tumor sites were performed in 38 patients (a main group), while 100 patients (a control group) underwent one of these operations. Two-stage operations, followed by removal of the suprasellar and basal regions of a tumor, are expedient for enhancing the efficiency of surgical treatment, reducing the incidence of complications associated with traumatic attempts at removing tumor parts hard-to-reach by transcranial or transsphenoidal approaches, as well as at reducing the number of relapses. At the first stage of surgical treatment it is advisable to make an intervention via transcranial access especially in cases of complex configuration of the suprasellar part of a tumor. The recommended interval between transcranial and transsphenoidal surgeries is 3-5 months. Two-stage surgical treatment does not lead to significant structural changes and to the increased number of complications, and to higher mortality rates as compared to one-stage surgery (transcranial or transsphenoidal surgeries alone).