Combined micro-endoscopic trans-sphenoid excisions of pituitary macroadenomas.

Refined microsurgical techniques with the operating microscope have greatly facilitated removal of pituitary tumors by the trans-sphenoid approach. However, extensions of macroadenomas in presellar and parasellar regions and in the lateral recesses of the sphenoid sinuses can be partially hidden, resulting in their removal by relatively blind curettage. In 37 patients with pituitary macroadenomas, the rigid 30 degrees angled fiberoptic nasoscope fitted to a suction-irrigation sheath was found to be highly beneficial. Hidden areas could be visualized in 84% of the patients and tumor residues detected in 40.5%. In the majority of the patients with detected tumor residues, adenomatous remnants were safely removed by meticulous endoscopic dissection under optimum visual control after the main part of the tumor had been removed with the operating microscope.