A preliminary surgical study on morphologic changes of anatomic structures of saddle area caused by sellar tumors

Objective: To observe morphologic changes of anatomic structures of saddle area caused by sellar tumors and explore corresponding surgical strategies. Methods: Morphological changes of anatomic structures were observed in 30 patients suffering sellar tumors received transcranial microsurgical operations, including 13 cases with pituitary adenoma, 8 craniopharyngioma, 6 tuberculum sellae meningioma ,1 astrocytoma, 1 Rathke' cleft cyst,and 1 epidermoid cyst. Intraoperative photos were taken and compared each other to evaluate the importance and value of microanatomy. Results: Pituitary adenomas mostly expanded from space 1. Space 1 and 2 were often used in these operations via anteriorly shifted pterional approach or subfrontal approach. Craniopharyngiomas expanded from posterior margin of optic chiasm with close relation to pituitary stalk. Several spaces were used in the operation via laterally shifted pterional approach. With more anteriorly origin, tuberculum sellae meningioma brought lateral and posterior oppression to optic nerve and optic chiasm. Space 1 was used in its operation and pituitary stalk was not easy to injury. Epidermoid cyst took on swollen growth and glioma took on invasive growth which made peripheral structures difficult to be identified. Rathke' cleft cyst originated from pituitary tissue and intraoperative conditions were various according to its sizes. Conclusions: For different origin positions, expansion directions of tumors and oppression directions of peripheral structures, operative spaces of sellar region are changed differently and their utilization values are various. According to the demand of exposure and resection for tumors, choice of operative approach and space should be individualized. To make good exposure, identify and preserve all small arteries in sellar region and retain integrity of pituitary stalk is common principle for sellar surgery.