Different types of combined endoscopic and transcranial approaches for complex giant pituitary adenomas: how I do it

Acta Neurochir (Wien). 2024 Nov 22;166(1):473. doi: 10.1007/s00701-024-06371-w.

Abstract

Background: Surgery for giant pituitary adenomas (GPAs) poses significant challenges, particularly when the tumor cannot be fully addressed using either the endoscopic endonasal approach (EEA) or the microscopic transcranial approach (MTCA) alone.

Method: We utilized two combined approaches for complex GPAs: 1) expanded endoscopic endonasal approach (EEEA) combined with microscopic pterional approach (MPA), and 2) EEEA combined with endoscopic transventricular approach (ETVA).

Conclusion: The combined approach is an effective surgical technique for complex GPAs. The EEEA-MPA approach is suitable for GPAs with superior and lateral extension, while the EEEA-ETVA approach is beneficial for tumors with lateral ventricular invasion.

Keywords: Combined approach; Endoscopic transventricular approach; Expanded endoscopic endonasal approach; Giant pituitary adenoma; Microscopic pterional approach.

MeSH terms

  • Adenoma* / diagnostic imaging
  • Adenoma* / pathology
  • Adenoma* / surgery
  • Adult
  • Endoscopy / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neuroendoscopy* / methods
  • Neurosurgical Procedures / methods
  • Pituitary Neoplasms* / diagnostic imaging
  • Pituitary Neoplasms* / pathology
  • Pituitary Neoplasms* / surgery
  • Treatment Outcome