Commentary “Efficacy of Trans-septal Trans-sphenoidal Surgery in Correcting Visual Symptoms Caused by Hematogenous Metastases to the Sella and Pituitary Gland”

This manuscript documents the efficacy of appropriately applied trans-sphenoidal decompression to reverse progressive visual loss in unfortunate patients who develop metastases to the pituitary. The authors' treatment improved vision in five of the seven patients. This information is important, and the authors are to be congratulated for their success despite the limited life expectancy of their patients. Interestingly, only two patients had diabetes insipidus at the time of presentation. The usual location for carcinomatous metastasis to the pituitary is the posterior lobe, and diabetes insipidus is an important part of the clinical presentation of most of these patients.

The authors emphasize that this surgery is not without risk. In fact, five patients developed complications. The most serious complication was spinal fluid leakage in one patient who required reoperation. Unfortunately, the patient developed meningitis and sepsis and died postoperatively.

It is important to realize that patients being treated for metastatic cancer who develop visual loss, headache, or diabetes insipidus may be harboring metastases to the pituitary region. In such cases, appropriate imaging studies and appropriate neurosurgical care may be indicated.