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

Romano, Antonio; Chibbaro, Salvatore; Marsella, M.; Oretti, Gabriele; Spiriev, Toma; Iaccarino, Corrado; Servadei, Franco

doi:10.1016/j.wneu.2010.02.024

Cited by 38 publications

(30 citation statements)

References 23 publications

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“…More recently, an alternative ‘above and below’ approach has been described by several authorities for the treatment of PAs with significant third ventricular extensions. It uses a simultaneous endoscopic transsphenoidal-transventricular technique and therefore obviates the need for a craniotomy [10, 24, 25]. …”

Section: Discussionmentioning

confidence: 99%

“…Several alternative approaches have been described, including the extended endoscopic transsphenoidal approach [4, 17], the staged transsphenoidal approach [1], the staged transcranial-transsphenoidal approach [2], the combined endoscopic transsphenoidal transventricular approach [10, 24, 25], and the simultaneous combined transcranial and transsphenoidal approach [2, 7, 19]. The latter, in particular, has the advantage of achieving radical tumour removal in a single setting of general anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

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Combined simultaneous transcranial and transsphenoidal resection of large-to-giant pituitary adenomas

et al. 2011

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BackgroundWhile large-to-giant pituitary adenomas (PAs) may be safely removed by experienced surgeons through a single route, the procedure is technically challenging. We present the outcome of a simultaneous combined transcranial and transsphenoidal approach and discuss its applications.MethodsA retrospective review was conducted on 12 consecutive patients. Surgical complications, visual and endocrinological functions, and tumour control were reviewed.ResultsThere were four men and eight women, with a mean age of 47.6 years. All but one patient had non-functioning PAs. The mean tumour height was 4.1 cm (range: 2.3–5.5). The predominant presenting symptoms were visual field loss in eight patients, headache in three patients and mental confusion in one patient. There was no operative mortality. Post-operative cerebrospinal fluid leakage occurred in one patient. Five of the eight patients who presented with visual field loss achieved full recovery, and three had partial improvement. Two patients developed permanent diabetes insipidus after surgery. Panhypopituitarism occurred in one patient. Gross total removal (GTR) was achieved in five, and subtotal removal (STR) in seven patients. Seven patients received post-operative external irradiation. All patients who had GTR remained tumour-free and all those with STR had stable diseases after a mean follow-up period of 53.1 months (range: 14.1–92.1).ConclusionThe simultaneous ‘above and below’ approach is a safe and effective surgical strategy for large-to-giant PAs, particularly when expertise in endoscopic transsphenoidal surgery is unavailable. Its use, however, should be limited to a carefully selected group of patients, and tailored to individual user’s expertise and experience.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Combined simultaneous transcranial and transsphenoidal resection of large-to-giant pituitary adenomas

et al. 2011

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“…The use of endoscopes for the simultaneous ‘above and below’ approach has been described previously [16–18]. These authorities combined the use of endonasal with transventricular endoscopes.…”

Section: Discussionmentioning

confidence: 99%

An endoscopic modification of the simultaneous ‘above and below’ approach to large pituitary adenomas

et al. 2011

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Surgical resections of large-to-giant pituitary adenomas (PA) are technically challenging procedures. Tumors with a fibrous consistency or ‘hour-glass’ configurations are particularly difficult to remove completely and safely through the transsphenoidal route alone. Although the transcranial approach can facilitate the removal of a large suprasellar mass, it may be associated with significant bleeding within the intradural space. A simultaneous microscopic transcranial and transsphenoidal approach has been described as an alternative surgical strategy. We have further modified this ‘above and below’ approach by adopting endoscopic techniques for the transsphenoidal part of the procedure. This modified approach has the advantages of requiring only one operating microscope, and permitting freer maneuvers and easier orientation for both surgical teams. We present two patients successfully treated with this approach. Complete tumor removal was achieved and both patients achieved satisfactory functional recovery.

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“…According to the relationship between giant adenoma and cavernous sinus, Goel et al divided pituitary adenomas into 4 grades and pointed out that the operation risk was high [3]. Some researchers used the endonasal endoscopic approach [5-7], the extended endoscopic endonasal transsphenoidal approach [8], the microscopic transsphenoidal approach [6], the extended pterional approach [3], the transsphenoidal-pterional approach [9], or the endoscopic transsphenoidal-ventricle approach [10-12] for tumor resection. However they did not accurately measure the extent of tumor removal.…”

Section: Introductionmentioning

confidence: 99%

Analysis of operative efficacy for giant pituitary adenoma

et al. 2014

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BackgroundSurgical treatment of giant pituitary adenomas is difficult due to complicated dissection of the sellar area. The extent of tumor resection affects the efficacy of surgical treatment. This study is to investigate the efficacy of microsurgical treatment for giant pituitary adenoma and to analyze the relationship between treatment efficacy and tumor resection extent.MethodsA retrospective analysis was performed in 36 patients who received microsurgery to remove giant pituitary adenomas. The sizes of tumors before and after surgery were calculated with a novel method called the “platform-like volume calculation formula”. The relationships between extent of resection and the visual impairment recovery, and improvement of serum hormone level before and after operation were analyzed.ResultsTwo deaths were observed after surgery. And the gross and near-total resection was achieved in 8 cases, subtotal resection in 8 cases, mostly partial resection in 15 cases, and partial resection in 5 cases. The average resection rate was 72.8%. The resection rate of tumor with cavernous sinus invasion was significantly lower than those of patients without cavernous sinus invasion (P < 0.05). The improvement rate of hormone level in functional adenoma was 80.0%. Follow-up observations were carried out for 3 ~ 28 months in 25 cases. Visual improvement was observed in 64.0% of the cases.ConclusionsMicrosurgical treatment can improve the visual impairment of the majority of cases and significantly decrease the serum hormone levels of functional adenoma. The extent of resection was significantly associated with cavernous sinus invasion.

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

Cited by 38 publications

References 23 publications

Combined simultaneous transcranial and transsphenoidal resection of large-to-giant pituitary adenomas

Combined simultaneous transcranial and transsphenoidal resection of large-to-giant pituitary adenomas

An endoscopic modification of the simultaneous ‘above and below’ approach to large pituitary adenomas

Analysis of operative efficacy for giant pituitary adenoma

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