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      Combined simultaneous endoscopic endonasal and microscopic transventricular surgery using a port retractor system for giant pituitary adenoma: A technical case report

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          Abstract

          Background:

          We report a case of a giant pituitary adenoma with marked extension into the third ventricle that was successfully removed using combined simultaneous endoscopic endonasal surgery (EES) and microscopic transventricular port surgery.

          Case Description:

          A 47-year-old woman, who complained of memory disturbance, had a giant pituitary adenoma with marked extension into the third ventricle that was causing obstructive hydrocephalus. She underwent combined EES and microscopic transventricular surgery using a port retractor system. Most of the tumor was resected from the EES side with assistance from the transcranial side with minimum cortical trajectory damage. The tumor was completely excised without any complications.

          Conclusion:

          For giant pituitary adenoma with marked extension into the third ventricle, combined simultaneous EES and transventricular surgery using a port retractor system is effective to maximize the extent of tumor resection while also preventing complications. Using port surgery on the transcranial side, microscopic secure dissection is possible with minimum additional cortical damage.

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          Endoscopic endonasal transsphenoidal approach to large and giant pituitary adenomas: institutional experience and predictors of extent of resection.

          Kyle Juraschka, Osaama Khan, Bruno L Godoy … (2014)
          OBJECT.: While the use of endoscopic approaches has become increasingly accepted in the resection of pituitary adenomas, limited evidence exists regarding the success of this technique for patients with large and giant pituitary adenomas. This study reviews the outcomes of a large cohort of patients with large and giant pituitary adenomas who underwent endoscopic endonasal transsphenoidal surgery at the authors' institution and focuses on identifying factors that can predict extent of resection and hence aid in developing guidelines and indications for the use of endoscopic endonasal transsphenoidal surgery versus open craniotomy approaches to large and giant pituitary adenomas.
          Article 0 comments Cited 56 times – based on 0 reviews     Review now
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            Endoscopic endonasal surgery for giant pituitary adenomas: advantages and limitations.

            Alessandro Paluzzi, Maria Koutourousiou, Carl H Snyderman … (2013)
            Giant pituitary adenomas (> 4 cm in maximum diameter) represent a significant surgical challenge. Endoscopic endonasal surgery (EES) has recently been introduced as a treatment option for these tumors. The authors present the results of EES for giant adenomas and analyze the advantages and limitations of this technique. The authors retrospectively reviewed the medical files and imaging studies of 54 patients with giant pituitary adenomas who underwent EES and studied the factors affecting surgical outcome. Preoperative visual impairment was present in 45 patients (83%) and partial or complete pituitary deficiency in 28 cases (52%), and 7 patients (13%) presented with apoplexy. Near-total resection (> 90%) was achieved in 36 patients (66.7%). Vision was improved or normalized in 36 cases (80%) and worsened in 2 cases due to apoplexy of residual tumor. Significant factors that limited the degree of resection were a multilobular configuration of the adenoma (p = 0.002) and extension to the middle fossa (p = 0.045). Cavernous sinus invasion, tumor size, and intraventricular or posterior fossa extension did not influence the surgical outcome. Complications included apoplexy of residual adenoma (3.7%), permanent diabetes insipidus (9.6%), new pituitary insufficiency (16.7%), and CSF leak (16.7%, which was reduced to 7.4% in recent years). Fourteen patients underwent radiation therapy after EES for residual mass or, in a later stage, for recurrence, and 10 with functional pituitary adenomas received medical treatment. During a mean follow-up of 37.9 months (range 1-114 months), 7 patients were reoperated on for tumor recurrence. Three patients were lost to follow-up. Endoscopic endonasal surgery provides effective initial management of giant pituitary adenomas with favorable results compared with traditional microscopic transsphenoidal and transcranial approaches.
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              Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of giant pituitary adenomas.

              Ricardo Komotar, Robert Starke, Sandeep V. Anand … (2012)
              Giant (>4 cm) pituitary macroadenomas often require surgery to decompress the optic nerves. Compared with traditional open or transsphenoidal microscopic methods, the extended endoscopic endonasal transsphenoidal approach offers the potential for aggressive resection via a minimal access corridor. We conducted a systematic review of the literature to further our understanding of the role of endoscopy in the management of these challenging lesions. MEDLINE search of the modern literature (1995-2010) to identify surgical series for pediatric and adult pituitary adenomas >4 cm in maximal diameter. Patient and tumor characteristics, resection, morbidity and visual outcome were compared by approach. Chi-square and Fisher's exact tests with post-hoc Bonferroni analysis were used for statistical analyses. Sixteen studies (478 patients) were included. Compared with the open cohort, the endoscopic cohort had higher rates of gross total resection (47.2% vs. 9.6%; P < 0.003) and improved visual outcome (91.1% vs. 45.7%; P < 0.003). The microscopic transsphenoidal cohort had lower rate of total resection and worse visual outcomes than the endoscopic group. There were no instances of postoperative CSF leak reported in the endoscopic group. The transcranial group had a higher rate perioperative mortality compared to the transsphenoidal group (P = 0.004). In select cases, the endoscopic endonasal approach is safe and effective for the treatment of giant pituitary adenomas, with the potential for gross total resection and improved visual outcome. CSF leak, which is a major limitation of the endonasal approach, may be avoided using meticulous multi-layer closure and vascularised nasoseptal flaps.
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                Author and article information

                Contributors
                Erika Yamada
                Hiroyoshi Akutsu
                Hiroyoshi Kino
                Shuho Tanaka
                Hidetaka Miyamoto
                Takuma Hara
                Masahide Matsuda
                Shingo Takano
                Akira Matsumura
                Eiichi Ishikawa
                Journal
                Journal ID (nlm-ta): Surg Neurol Int
                Journal ID (iso-abbrev): Surg Neurol Int
                Title: Surgical Neurology International
                Publisher: Scientific Scholar (USA )
                ISSN (Print): 2229-5097
                ISSN (Electronic): 2152-7806
                Publication date Collection: 2021
                Publication date (Electronic): 08 March 2021
                Volume: 12
                Electronic Location Identifier: 90
                Affiliations
                [1 ]Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan.
                [2 ]Department of Otolaryngology, University of Tsukuba, Tsukuba, Ibaraki, Japan.
                Author notes
                [* ] Corresponding author: Hiroyoshi Akutsu, Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan. akutsuh@ 123456md.tsukuba.ac.jp
                Article
                Publisher ID: 10.25259/SNI_826_2020
                DOI: 10.25259/SNI_826_2020
                PMC ID: 7982105
                PubMed ID: 33767894
                SO-VID: c2606b5f-f247-4316-8e28-394feea10cde
                Copyright © Copyright: © 2021 Surgical Neurology International
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Date received : 16 November 2020
                Date accepted : 01 February 2021
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: combined endoscopic endonasal surgery and transcranial surgery,giant pituitary adenoma,minimally invasive surgery,port surgery
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: combined endoscopic endonasal surgery and transcranial surgery, giant pituitary adenoma, minimally invasive surgery, port surgery

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