OBJECTIVE: We describe a combined simultaneous approach to giant pituitary tumors and present a review of 10 patients undergoing this procedure with emphasis on patient selection, surgical technique, and results. METHODS: A retrospective review was performed of patients who had undergone a combined, simultaneous transsphenoidal and pterional craniotomy approach to a giant pituitary adenoma. Visual findings, endocrine presentation, and tumor type were compiled. Tumor stage and grade (Hardy classification) were based on MRI and intraoperative findings. RESULTS: Gross total resection of tumor was achieved in 4 of 10 patients, near total (>90%) in 2 of 10, and subtotal (80-90%) in 4. At the time of follow-up (average, 29.7 months; range, 17-44 months), stereotactic radiosurgery had been performed in 2 patients. Of the 9 patients who presented with visual field loss, all had improvement at 1-month follow-up. At 6 months follow-up, resolution was complete in 5 patients and partial in 4. No patient had worsening of vision. Hypopituitarism persisted in all 5 patients who presented with it preoperatively. CONCLUSION: The combined, simultaneous transsphenoidal and pterional approach described is indicated for a small subset of patients with giant (>3 cm) clinically nonfunctional pituitary tumors who meet the criteria of tumor configuration outlined where the surgeon cannot achieve complete resection by a single approach. We propose adding a new Hardy's scheme subtype, Stage B-a, to describe giant pituitary tumors with a dumbbell configuration. Combining both craniotomy and transsphenoidal approaches may achieve the goal of tumor resection with less need for multiple sequential operations.
OBJECTIVE: We describe a combined simultaneous approach to giant pituitary tumors and present a review of 10 patients undergoing this procedure with emphasis on patient selection, surgical technique, and results. METHODS: A retrospective review was performed of patients who had undergone a combined, simultaneous transsphenoidal and pterional craniotomy approach to a giant pituitary adenoma. Visual findings, endocrine presentation, and tumor type were compiled. Tumor stage and grade (Hardy classification) were based on MRI and intraoperative findings. RESULTS: Gross total resection of tumor was achieved in 4 of 10 patients, near total (>90%) in 2 of 10, and subtotal (80-90%) in 4. At the time of follow-up (average, 29.7 months; range, 17-44 months), stereotactic radiosurgery had been performed in 2 patients. Of the 9 patients who presented with visual field loss, all had improvement at 1-month follow-up. At 6 months follow-up, resolution was complete in 5 patients and partial in 4. No patient had worsening of vision. Hypopituitarism persisted in all 5 patients who presented with it preoperatively. CONCLUSION: The combined, simultaneous transsphenoidal and pterional approach described is indicated for a small subset of patients with giant (>3 cm) clinically nonfunctional pituitary tumors who meet the criteria of tumor configuration outlined where the surgeon cannot achieve complete resection by a single approach. We propose adding a new Hardy's scheme subtype, Stage B-a, to describe giant pituitary tumors with a dumbbell configuration. Combining both craniotomy and transsphenoidal approaches may achieve the goal of tumor resection with less need for multiple sequential operations.
Authors: Andre Beer-Furlan; Alexander I Evins; Luigi Rigante; Giulio Anichini; Philip E Stieg; Antonio Bernardo Journal: J Neurol Surg B Skull Base Date: 2014-03-12
Authors: Nikita Lakomkin; Jamie J Van Gompel; Kalmon D Post; Steve S Cho; John Y K Lee; Constantinos G Hadjipanayis Journal: J Neurooncol Date: 2021-02-21 Impact factor: 4.130
Authors: Debraj Mukherjee; Hasan A Zaidi; Thomas A Kosztowski; Aditya Halthore; George I Jallo; Roberto Salvatori; David C Chang; Alfredo Quiñones-Hinojosa Journal: Childs Nerv Syst Date: 2009-11-10 Impact factor: 1.475