Anatomical Correlates and Subtleties of Surgery for Pituitary Tumors- A Review of Personal Understanding.

The authors review the anatomy of the pituitary gland on the basis of cadaver dissection studies and anatomy of dural relationships of pituitary tumors and its extensions on the basis of a 35-year-old experience of surgically treating pituitary tumors. Perfect understanding of anatomical correlates and nuances of pituitary tumor surgery is essential to achieve satisfactory surgical results. The pituitary gland is located in a specially enclosed cavity that is neither intracranial nor extracranial. It is covered strategically by meninges. Pituitary gland has a close relationship with cavernous sinuses and sphenoid air sinus. Pituitary tumors range widely in their size. Whilst microadenomas are generally associated with hormonally active tumors, large and giant sized tumors are usually hormonally non-functional. Surgical issues are unique for all sizes of pituitary tumors. Giant pituitary tumors grow in size, but a majority of them are confined to dural compartmental space. Recently proposed classification schemes have enhanced the understanding of anatomical subtleties and dural relationships of growing and giant pituitary tumors.