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January 8, 1968

Selective Anterior Hypophysectomy in the Treatment of Diabetic Retinopathy: A Transsphenoidal Microsurgical Technique

Author Affiliations

From the Department of Neurosurgery, Notre Dame Hospital, and the University of Montreal (Dr. Hardy), and Chicago Wesley Memorial Hospital and Northwestern University Medical School, Chicago (Dr. Ciric). Dr. Ciric is now at the Evanston (Ill) Hospital.

JAMA. 1968;203(2):73-78. doi:10.1001/jama.1968.03140020001001

On the basis of Houssay's phenomenon and of Poulsen's report of a patient who had a selective necrosis of the anterior lobe of the hypophysis with a permanent cure of the diabetic retinopathy, it would seem that the most physiologic approach to the treatment of progressive diabetic retinopathy would be a selective and complete anterior hypophysectomy. In order to accomplish this, a microsurgical technique for dissection of the hypophysis through a transsphenoidal midline approach was developed and used in 17 consecutive cases. A selective anterior hypophysectomy was achieved in 11 patients. The other six patients had a total hypophysectomy. Significant reduction in the insulin requirements occurred in all of the patients. Diabetes insipidus occurred in six patients. Within the follow-up period of a few months to two years, it appeared that diabetic retinopathy might have been favorably influenced in 15 patients.