Daisuke Kuga1, Masahiro Toda2, Hiroyuki Ozawa3, Kaoru Ogawa3, Kazunari Yoshida1. 1. Department of Neurosurgery, Keio University School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan. 2. Department of Neurosurgery, Keio University School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan. Electronic address: todam@keio.jp. 3. Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan.
Abstract
BACKGROUND: The endoscopic endonasal approach is widely used for treating giant pituitary adenomas. However, a small subset of tumors is still challenging to treat, and the risk of complications increases when an endoscopic endonasal approach alone is used. The simultaneous combined endoscopic endonasal and transcranial approach is a surgical option for such difficult adenomas; however, very few studies have described the technical nuances and benefits of this approach. METHODS: We treated 3 patients with giant pituitary adenoma and 1 patient with pituicytoma. Radiologic findings and clinical outcomes were retrospectively reviewed. RESULTS: All patients had preoperative visual disturbances. A pterional approach was combined with an endoscopic endonasal approach to treat all the patients. Near-total and subtotal tumor removal was accomplished in 3 patients; however, only partial tumor removal was possible in 1 patient. Postoperative visual function improved in 3 patients, but there were no changes in 1 patient. There were no major complications; however, each patient developed either adrenocorticotropic hormone (ACTH) and thyroid-stimulating hormone deficiency or ACTH deficiency and persistent diabetes. Importantly, no cerebrospinal fluid leakage was observed in the patients. CONCLUSIONS: Our simultaneous combined endoscopic and transcranial approach offers safe tumor resection and a low rate of complications. In this procedure, it is important that tumor debulking be performed by the main surgeon via a single surgical route and not by 2 surgeons using the simultaneous endonasal and transcranial approach, to avoid interference in the surgical field. This approach may be considered as a surgical option for carefully selected tumors in the sellar region.
BACKGROUND: The endoscopic endonasal approach is widely used for treating giant pituitary adenomas. However, a small subset of tumors is still challenging to treat, and the risk of complications increases when an endoscopic endonasal approach alone is used. The simultaneous combined endoscopic endonasal and transcranial approach is a surgical option for such difficult adenomas; however, very few studies have described the technical nuances and benefits of this approach. METHODS: We treated 3 patients with giant pituitary adenoma and 1 patient with pituicytoma. Radiologic findings and clinical outcomes were retrospectively reviewed. RESULTS: All patients had preoperative visual disturbances. A pterional approach was combined with an endoscopic endonasal approach to treat all the patients. Near-total and subtotal tumor removal was accomplished in 3 patients; however, only partial tumor removal was possible in 1 patient. Postoperative visual function improved in 3 patients, but there were no changes in 1 patient. There were no major complications; however, each patient developed either adrenocorticotropic hormone (ACTH) and thyroid-stimulating hormone deficiency or ACTH deficiency and persistent diabetes. Importantly, no cerebrospinal fluid leakage was observed in the patients. CONCLUSIONS: Our simultaneous combined endoscopic and transcranial approach offers safe tumor resection and a low rate of complications. In this procedure, it is important that tumor debulking be performed by the main surgeon via a single surgical route and not by 2 surgeons using the simultaneous endonasal and transcranial approach, to avoid interference in the surgical field. This approach may be considered as a surgical option for carefully selected tumors in the sellar region.
Authors: Shin Heon Lee; Chang-Min Ha; Sang Duk Hong; Jung Won Choi; Ho Jun Seol; Do-Hyun Nam; Jung-Il Lee; Doo-Sik Kong Journal: Front Oncol Date: 2022-05-04 Impact factor: 5.738
Authors: David Netuka; Andre Grotenhuis; Nicolas Foroglou; Francesco Zenga; Sebastien Froehlich; Florian Ringel; Nicolas Sampron; Nick Thomas; Martin Komarc; Martin Majovsky Journal: Int J Endocrinol Date: 2022-04-11 Impact factor: 2.803