Extracapsular Dissection and Extended Transplanum Approach for Endoscopic Endonasal Resection of Giant Pituitary Adenoma; Experience with 44 cases

Abstract

Background: Nobody nowadays is skeptic about superiority of endoscopic TSS over conventional one. Extended approach by going through tuberculum sella and planum sphenoidale may provide greater exposure for removing of retrochiasmatic craniopharyngioma and tuberculum sella meningioma and large superiorly extending adenoma pituitary adenoma.

Materials and Methods: Since 2004 we have done pure endoscopic endonasal surgery, and in last three years we used those above mentioned technique in 44 huge and giant cases. In 17 patients extended approach and in 35 patients’ extracapsular dissection were performed. Due to high frequency of firm and previously surgical tried in this group it’s not surprising that in 8 giant cases both techniques were used.

Results: In all cases we were able to perform total resection and remove the subfrontal intraventricular and interpeduncular fossa extensions set aside cavernous sinus involvement. No patient experience worsening of vision or new neurological deficit. In 60 % of cases the pituitary gland was saved and at three month postop we observed acceptable adenohypophysis physiology. In five cases transient diabetes insipidus occurred. In one patient we have late post op CSF leak that with empirical antibiotic and bed rest her problem resolved

Conclusion: Came out from sheer preeminence of endoscopy in endonasal approach are provided ability for extracapsular approach and extetended transplanum approach. Using these two technique surgeon can overcome giant and huge pituitary adenoma dilemma very safe and successful. Recruiting these strategy need for added transcranial approach and staged transsphenoidal surgery are approximately obviated.