• Mauro Loyo-Varela, Tenoch Herrada-Pineda, Francisco Revilla-Pacheco, and Salvador Manrique-Guzman.
• Centre of Surgery for Pituitary Tumours, Department of Neurosurgery, America British Cowdray Medical Center, Mexico City, Mexico. neuro_mloyov@yahoo.com
• World Neurosurg. 2013 Feb 1;79(2):331-6.

ObjectiveTo report the efficacy, safety, and outcomes through time of the biggest series to our knowledge of pituitary surgery using transcranial, transsphenoidal, and endoscopic techniques.MethodsAn observational, retrospective, and descriptive review was performed of 3004 patients surgically treated by the senior author from 1973 to June 2011 in Mexico City. A sublabial approach was used in 3000 patients, and a transnasal approach was used in the remaining 4 patients. Tumors were classified according to size as microadenomas or macroadenomas.ResultsDuring the time period of this study, 3004 patients were surgically treated; there were 510 prolactinomas, 822 growth hormone adenomas, 62 adrenocorticotropic hormone-producing adenomas, 8 tumors that produced Nelson syndrome, and 1562 adenomas that were not biologically active. The cure rate of prolactinoma was 82% for microadenomas and 9% for macroadenomas. Gender distribution showed a male predominance of 57.1%. Cure rate for growth hormone adenomas was 87%. Adrenocorticotropic hormone adenomas showed no cure rate; surgery simply aided pharmacologic control. Global mortality rate was 1.6%. The main complications were cerebrospinal fluid fistula, diabetes insipidus, and meningitis.ConclusionsThe sum of this 38-year experience of managing pituitary pathology and its surgical treatment shows the importance of working together with other specialists such as endocrinologists, ophthalmologists, and radiologists. The correct treatment approach for each case must be individually selected. Transsphenoidal surgery is an effective and safe treatment for most patients with pituitary adenoma and could be considered the first-choice therapy in all cases except for prolactinomas that respond to pharmacologic therapy (dopamine agonist).Copyright © 2013 Elsevier Inc. All rights reserved.

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