EXTRASELLAR EXTENSION OF PITUITARY ADENOMAS

CLINICAL AND NEURORADIOLOGICAL CONSIDERATIONS

¹ Chief of Neurosurgery, Bronx Veterans Administration Hospital; Clinical Professor of Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
² Chief of Radiology, Bronx Veterans Administration Hospital; Assistant Clinical Professor of Radiology, Bellevue Hospital, New York University

1. The roentgenological and surgical treatment of pituitary adenomas and of lesions which may simulate them clinically as well as on plain skull roentgenograms such as craniopharyngiomas, meningiomas, chordomas, carcinomas and aneurysms with extension into sellar and parasellar space, requires an early and exact determination of the size of the lesion, the predominant direction of its extension and, if possible, of its etiology.

2. In most instances, the roentgenograms and clinical findings do not give a definite clue as to the etiology of a tumor occupying the sella turcica or any exact information as to the size and direction of its extrasellar extension.

3. Cerebral pneumography and angiography are the only methods which permit an accurate estimate of intracranial tumor extension of pituitary adenomas, and should be performed in all pituitary tumor suspects before radiation therapy or surgical intervention is contemplated.

4. The neuroradiological diagnosis of expanding pituitary neoplasms requires not only familiarity with the normal and pathological topographical as well as roentgenological anatomy of the sella turcica and its adjacent structures, but also knowledge of the differential diagnostic characteristics of other lesions in the sellar area and also some awareness of the clinicopathological manifestations of pituitary tumor expansion. Although all these elements could hardly be discussed completely or in detail, some aspects necessary for a fuller understanding of the various phenomena of extrasellar extension of pituitary adenomas and the problems of their differential diagnosis were considered.

5. Based on available data of the literature and our own experience, the elements of the pneumographic and angiographic diagnosis of pituitary adenomas are illustrated and described, particularly in respect to the various pathways of suprasellar extension. A discussion of the various, partially controversial opinions expressed in the literature concerning the relative values of either method is added.

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