Endoscopic endonasal approach for resection of giant nonfunctional pituitary adenoma

The giant pituitary adenoma (GPA)> 4 cm is considered a surgical challenging pathology and associated with higher surgical complications compared to non-giant pituitary adenoma [1]. These tumors are invasive and had extension to nearby neurovascular structures including cranial nerves and interna...

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Bibliographic Details
Published in:Clinical neurology and neurosurgery 2023-07, Vol.230, p.107725, Article 107725
Main Authors: Muhsen, Baha’eddin A., Najera, Edinson, Cappello, Zachary, Borghei-Razavi, Hamid, Recions, Pablo F.
Format: Article
Language:English
Subjects:
Adenoma
Carotid artery
Cerebrospinal fluid
Compression
Cranial nerves
Endoscopic endonasal
Endoscopy
Fecal incontinence
Gait
Giant pituitary adenoma
Hydrocephalus
Hypopituitarism
Pituitary
Skull
Transsphenoidal
Tumors
Ventricle
Ventricles (cerebral)
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Summary:The giant pituitary adenoma (GPA)> 4 cm is considered a surgical challenging pathology and associated with higher surgical complications compared to non-giant pituitary adenoma [1]. These tumors are invasive and had extension to nearby neurovascular structures including cranial nerves and internal carotid artery. Endoscopic endonasal approach (EEA) is increasingly used in the last two decades, however tumors with significant height extension in the supraseller region makes surgeons in favor of transcranial approaches or combined approaches [2]. The accompanied symptoms arise from compression of neighboring structures as well as hypopituitarism [3]. In this video we present 65 year old male with PMH significant for HTN who presented with 2–3 months retro-orbital headaches, confusion, gait instability, urinary/fecal incontinence, found to have 5.1 × 2.1 × 2 cm sellaer-suprasellar mass compressing the floor of the third ventricle, mammillary body, and optic apparatus. The mass was associated with hydrocephalus. The endoscopic endonasal skull base approach (trans-sellar, transtubercular) was performed with significant tumor resection without a need for trans cranial approach. A titanium clips was used to reconstruct the diaphragma sella which was very helpful technique to change high flow CSF leak to low flow. The postoperative course of the patient was smooth with improved gait, memory, and vision. He was kept on a hormonal replacement for hypopituitarism.
ISSN:0303-8467
1872-6968
DOI:10.1016/j.clineuro.2023.107725