Combined endoscopic transsphenoidal-transventricular approach for resection of a giant pituitary macroadenoma

OBJECTIVES: Sellar lesions, such as pituitary adenomas, even when extended
to the suprasellar space may be usually removed through a trans-sphenoidal
approach. Larger lesions extending well beyond the edges of the sellar
diaphragm such as giant adenomas are best controlled with craniotomy and/or a
combined approach that implies both, transphenoidal and transcranial route.
Currently, the availability of more sophisticated endoscopes in this type of
surgery has provided optimal angles of view and rendered the trans-sphenoidal
route less invasive yet, more effective.
CASE DESCRIPTION: The authors report a case of a giant pituitary adenoma
successfully managed by a simultaneous, combined endoscopic trans-sphenoidal-
transventricular approach.
CONCLUSION: In selected case of giant pituitary adenoma with ventricular
extension, this technique may help to achieve a gross total removal avoiding the
need of staged procedures allowing also a direct visualization of the extent of
removal. Finally this approach can potentially improve gross total resection rate
of different types of tumor involving this region such as cranipharyngiomas while
reducing morbidity and mortality.