Combined Endoscopic Transsphenoidal and Tubular Retractor-Assisted Transventricular Approach for Giant Pituitary Adenomas.

Autor: Guinto-Nishimura GY; Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico., Caballero-Delgado S; Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico., Eguiluz-Meléndez AG; Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico., Ortega-Porcayo LA; Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico., Valencia-Ramos C; Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico., Aragon-Arreola JF; Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico., Portocarrero-Ortiz L; Neuroendocrinology Service, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico., Sangrador-Deitos MV; Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico., Gómez-Amador JL; Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico. Electronic address: jlga@neurocirugia-innn.com.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2021 Nov; Vol. 155, pp. e761-e769. Date of Electronic Publication: 2021 Sep 06.
DOI: 10.1016/j.wneu.2021.08.135
Abstrakt: Background: Surgical resection remains the standard treatment for most giant pituitary adenomas (GPAs). The selected surgical approach for these complex lesions depends mainly on their extension. Single approaches may be limited in some cases presenting with invasion into multiple compartments, thereby limiting extent of resection.
Methods: We report a series of patients with GPA operated on through a combined approach involving an endoscopic endonasal transsphenoidal approach and a tubular retractor-assisted transventricular approach, describing the technique, its indications, limitations, and outcomes. Baseline and postoperative clinical, functional, and morphologic variables were documented up until each patient's last follow-up visit.
Results: Five patients harboring tumors extending into the third and lateral ventricles were included. Mean extent of resection was 94.6%. Mean follow-up was 39.4 months. One patient presented with a growth hormone-secreting GPA, who achieved remission after repeat resection during follow-up. There were no intraoperative complications, and 1 patient required reoperation for cerebrospinal fluid leak repair. One patient received adjuvant radiotherapy, and 3 patients remained stable requiring no additional treatment. All patients maintained an adequate postoperative functional status.
Conclusions: The combined approach herein described may be a safe and effective option for some patients with GPAs extending into the third and lateral ventricles. An adequate patient selection is mandatory to exploit the benefits of each individual approach.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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