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

The authors reviewed seven patients who underwent trans-septal and trans-sphenoidal surgery to correct visual symptoms caused by hematogenous metastases to the sella and pituitary gland. Gross total resection was achieved in a minority of patients. Therefore, the authors conclude that this type of surgery is appropriate for the treatment of visual symptoms, which improved in five of the seven patients. One patient died 30 days after surgery.

Given the population of patients, this outcome is not surprising. It underscores the issue that patients with advanced systemic malignancies are high surgical risks. Compared with patients with benign pituitary adenomas, these patients represent a different population. Therefore, they should provide appropriate informed consent before surgery. As the authors acknowledge, the complication rate is high: cerebrospinal fluid leakage in three patients, diabetes insipidus in two, anterior pituitary dysfunction in two, and one death related to surgery. In general, this surgical approach could be recommended for a select group of patients with malignancies and significant visual impairment.