Combined endoscopic and microscopic transnasal approach for removal of large pituitary macroadenomas extending to paranasal sinuses
Kombinirani endoskopsko-mikroskopski transnazalni pristop za odstranitev velikih hipofiznih makroadenomov s širjenjem v obnosne votline

english

2009

volume 14, issue 30

Pituitary Neoplasms   Surgery    Endoscopy    Microsurgery    Sphenoid Bone   Middle Age    Nasal Cavity    Paranasal Sinus Neoplasms   Cavernous Sinus   Adenom   tumor 

Slovensko zdravniško društvo, Združenje za endoskopsko kirurgijo

Introduction. Removal of large pituitary macroadenomas with extrasellar extension to paranasal sinuses is a challenging field of skull base surgery that neccesiates cooperation between a neurosurgeon and arinologist. Combined endoscopic and microscopic transnasal approach extends the classic exposure via the transsphenoidal approach for intra-and suprasellar macroadenomas and gains added exposure of the parasellar, ethmoid and clival regions. Methods and Patients. Three patients with large nonsecretory intra-extracranial macroadenomas and panhypopituitarism were operated on by combined microscopic and endoscopic approach. In all cases intranasal, intraethmoid and intrasphenoid parts of macroadenoma were removed first by endoscopic techniquefollowed by microscopic technique of removal of the intrasellar, suprasellar and parasellar parts of the tumor. One patient had a previous transcranial surgery four years ago. Other two patients had tumors of similar large size, but underwent only one-staged transnasal surgery. Results. In all cases, the tumor was gross-totally removed from all extrasellar parts, except from parasellar space where incomplete removal was revealed by postoperative MRI scan. Visual symptoms were improved in all patients. Intraoperative CSF leak occured in one patient and was succesfully treated by lumbar drainage. She also had a mild transient diabetes insipidus. There were no additional neurological deficits and no rhinological problems.

10.02.2010