Resumen

LOPEZ ARBOLAY, Omar; GONZALEZ GONZALEZ, Justo L.; VALDES LORENZO, Nedel  y  MORALES SABINA, Osmany. Transsphenoidal approaches: first option for injuries of the sellar region with surgical criterion. Rev Cubana Endocrinol [online]. 2004, vol.15, n.3. ISSN 1561-2953.

The tumoral injuries are the most common of the diverse injuries appearing in the sellar region. Among them, the hypophyseal adenomas are the third type of the most frequent primary tumor in the central nervous system. The surgical approaches used for their solution are transcranial and transsphenoidal. We analized the results of sellar surgery during the last 8 years at "Hermanos Ameijeiras" Hospital through variables such as approach, type of injury, imaging and endocrinological characteristics, postoperative evolution, mortality and complications. 273 injuries were operated on (18 transcranial and 255 transphenoidal), 222 adenomas (150 functioning and 72 nonfunctioning), 27 arachnoidoceles, 13 fistulas of cerebrospinal fluid and other 11 tumoral injuries. The nonofunctioning adenomas were 70 macroadenomas and 2 microadenomas, whereas the functioning were 84 macroadenomas and 66 microadenomas. The control was always higher in microadenomas. 53,8 % of the fistulas were resolved. In patients with empty sella, the campimetric defect improved in 69,2 % and fistula was solved in 71,4 %. The evaluation by images in the postoperative of the rest of the injuries showed that of 6 craniopharyngiomas, total exeresis was attained in 5 predominantly cystic, and partial exeresis in one. The rest of the injuries were totally resected. Operative morbidity was 18,31 % in the whole series. It was significantly lower in the transsphenoidal approaches. Mortality was only present in transcranial approaches and it accounted for 0.73. The results in this study show that the transsphenoidal approaches are useful and reliable methods to treat sellar injuries.

Palabras clave : Sellar region; transsphenoidal; transcranial,; hypophyseal adenomas; fistulas.