Modified expanded endonasal approach for the large skull based giant pituitary adenoma

Abstract

Giant pituitary adenomas are among the most challenging issues of neurosurgery. During last decades, extended endoscopic endonasal approach has become more preferable than transcranial route, due to several advantages. However, large skull base defects associated with endoscopic approach lead to high rate of cerebrospinal fluid leakage and fistula formation. In this paper we describe our technique for the large based giant pituitary adenoma. The key point of this procedure is to preserve anterior skull base structures despite the large skull base occupation by the tumor, which in turn will prevent CSF leak.A 56-year-old female patient was referred to our department with a significantly decreased peripheral vision, blurry vision and pituitary insufficiency. Preoperative imaging revealed a giant pituitary adenoma with complete filling of sphenoid sinus, extension to the anterior fossa along planum sphenoidale. The distance between the dorsum sellae and the anterior border of the tumor, measured 42 mm in the sagittal plane. The tumor was compressing the corpus callosum superiorly and occupying anterior part of third ventricle. Despite wide boundaries of the tumor we decided to proceed with endoscopic approach.

Keywords

• Suprasellar tumor
• Transtuberculum transplanum approach
• Extended endoscopic transsphenoidal approach
• Cerebrospinal fluid leak
• Skull base reconstruction
• Leak-proof reconstruction