The Surgical Treatment Of Invasive Pituitary Adenoma Enfolding The Anterior Communicating Artery Complex

Objective: To describe the clinical features, performance of imaging and microsurgical treatment of the invasive pituitary adenoma enfolding anterior communicating artery complex.Methods: The extended subfrontal combined extradural and intradural approach has been used to resect adenoma. Dissection of tumor which enclose the anterior communicating artery complex have been performed by grasping the tumor from both proximal A1 segment of anterior cerebral artery to both distal A2 and anterior communicating artery, if interface between arteries and adenoma has been clean. If not, we have not forcibly resected tumor. Mechanical arterial spasm was prevented by topical sodium nitroprusside.Results: At surgery, the anterior communicating artery complexes of ten patients have been wrapped by tumor to varying degree. Eight cases have been completely wrapped, and there have been clean interface between branches and adenoma in 5 patients, the senior author could radically removed tumor. The residual tumor was left on anterior communicating artery complex in the other three completely wrapped ones, because the arachnoid plane was ruptured by tumor. True cavernous invasion around the carotid were found in 2 cases while enveloping the anterior cerebral artery complex, partial removal have been done. The postoperative KPS score was 90~100 in 9 patients. One patient died of acute pulmonary embolism. Postoperative visual function tests, including visual acuity and visual fields, showed improvement in all patients execept had been blind.Conclusion: Every attempt should be made to preserve anterior communicating artery complex, which often adheres closely to the tumors. After the separation, it should take effort to prevent the cerebral vasospasm.