Combined Endoscopic Transsphenoidal–Transventricular Approach for Resection of a Giant Pituitary Macroadenoma

Objectives Sellar lesions, such as pituitary adenomas, even when extended to the suprasellar space may be usually removed through a trans-sphenoidal approach. Larger lesions extending well beyond the edges of the sellar diaphragm such as giant adenomas are best controlled with craniotomy and/or a co...

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Bibliographic Details
Published in:World neurosurgery 2010-07, Vol.74 (1), p.161-164
Main Authors: Romano, Antonio, Chibbaro, Salvatore, Marsella, Marco, Oretti, Gabriele, Spiriev, Toma, Iaccarino, Corrado, Servadei, Franco
Format: Article
Language:English
Subjects:
Adenoma - diagnosis
Adenoma - surgery
Aged
Biological and medical sciences
Diabetes Insipidus - etiology
Endoscopy
Endoventricular lesion
Female
Giant pituitary macroadenoma
Humans
Image Processing, Computer-Assisted
Magnetic Resonance Imaging
Medical sciences
Minimally Invasive Surgical Procedures - methods
Neuroendoscopy - methods
Neurologic Examination
Neurosurgery
Pituitary Neoplasms - diagnosis
Pituitary Neoplasms - surgery
Postoperative Complications - etiology
Sphenoid Sinus - surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Transsphenoidal approach
Transventricular approach
Ventriculostomy - methods
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Summary:Objectives Sellar lesions, such as pituitary adenomas, even when extended to the suprasellar space may be usually removed through a trans-sphenoidal approach. Larger lesions extending well beyond the edges of the sellar diaphragm such as giant adenomas are best controlled with craniotomy and/or a combined approach that implies both, transphenoidal and transcranial route. Currently, the availability of more sophisticated endoscopes in this type of surgery has provided optimal angles of view and rendered the trans-sphenoidal route less invasive yet, more effective. Case Description The authors report a case of a giant pituitary adenoma successfully managed by a simultaneous, combined endoscopic trans-sphenoidal-transventricular approach. Conclusion In selected case of giant pituitary adenoma with ventricular extension, this technique may help to achieve a gross total removal avoiding the need of staged procedures allowing also a direct visualization of the extent of removal. Finally this approach can potentially improve gross total resection rate of different types of tumor involving this region such as cranipharyngiomas while reducing morbidity and mortality.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2010.02.024