Simultaneous combined supra-infrasellar approach for giant/large multilobulated pituitary adenomas.

Abstract

Surgical treatment of few complex pituitary adenomas, mostly large/giant and multilobulated, still remains troublesome. We present our case series using a simultaneous combined supra-infrasellar approach for these tumors. We retrospectively reviewed our 29 consecutive patients who have undergone procedures using this approach since 2004. Preoperative characteristics and surgical outcomes were reviewed. Total removal of the adenoma was achieved in 7 cases, subtotal removal in 21 cases, and partial removal in 1 case. Although surgical complications apart from pituitary insufficiency were noted in 12 patients, most were transient but permanent oculomotor nerve palsy and worsening of preoperative visual disturbance developed in 2 and 1 patient, respectively. Because these complex adenomas are not only large and invasive but also tend to lack a well-defined tumor capsule, the combined approach was effective for the accurate and safe removal by manipulating from both sides. The present single-stage approach is a viable option for these few selected patients.