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September 1967

Cryohypophysectomy and Transfrontosphenoidal Craniotomy in Pituitary Tumors

Author Affiliations

Los Angeles
From the Department of Surgery/Neurosurgery, University of California at Los Angeles School of Medicine, Los Angeles.

Arch Otolaryngol. 1967;86(3):265-267. doi:10.1001/archotol.1967.00760050267005

I WOULD like to emphasize a different approach to the pituitary gland and tumors which is not, as yet, popular with all neurosurgeons. Nevertheless, my general attitude about the art and practice of surgery is that one should be able to perform a given operation, in this instance hypophysectomy, in as many ways as possible. The particular approach can then be adapted to the particular clinical problem.

American physicians are reluctant to recommend surgical hypophysectomy, and, consequently, I turned to a stereotaxic approach to the pituitary in 1959. Initially, radioactive90yttrium spheres were stereotaxically implanted into the pituitary gland for the treatment of metastatic mammary cancer. This technique of radiohypophysectomy, which has been used in England, France, and Sweden, accomplished quite satisfactory necrosis of the adenohypophysis. However, I experienced a 15% incidence of cerebrospinal rhinorrhea and meningitis and a 12% incidence of optic and oculomotor nerve palsies. Consequently, in

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