gms | German Medical Science

Objective: A transsphenoidal technique in order to achieve an optimal removal of large and giant pituitary adenomas is presented. This technique can be used both in microsurgical and in endoscopic approaches.

Methods: A series of 42 patients affected by large (min. diam. >4 cm) or giant (min. diam. >6 cm) pituitary adenomas was operated on from 2001 through to 2006 adopting a particular microsurgical transsphenoidal technique, in order to avoid the occurrence of a previously marked intraoperative empty sella and the eventual related problems. If surgical removal starts from the intra and suprasellar central parts of the adenoma, the suprasellar cisternal plane can go down into the sella turcica and even into the sphenoidal sinus, laterally compressing parts of the tumour and possibly provoking injuries by traction of the important suprasellar structures. These compressed lateral parts of the tumour are difficult to remove without provoking intraoperative CSF fistula or other possible complications. In order to avoid a previously marked intraoperative empty sella, the lateral intrasellar parts of the tumor should be removed at first, opening only the lateral parts of peritumoral dura mater at the beginning. In this way, the central part of the dura mater remains in support of the intra- and suprasellar central portions of the tumor and the suprasellar cisternal plane. After removal of lateral intra- and suprasellar parts of the tumour, the central part of the peritumoral dura mater is cut and the central intra- and suprasellar parts of the tumor are removed.

Results: By this surgical technique, we achieved optimal tumor removal in the majority of patients without neurological complications, especially avoiding intraoperative CSF fistulas.

Conclusions: Our favourable results indicate that this microsurgical and possibly endoscopic technique can be very useful for the removal of large and giant pituitary adenomas.