Endoscopic Endonasal Approach for Giant Pituitary Adenoma Occupying the Entire Third Ventricle: Surgical Results and a Review of the Literature
| Autor: | Biren Khimji Patel, Mohamed Amjad Jamaluddin, Prakash Nair, H. V. Easwer, Harshavardhan P. Biradar, Tobin George, Sandeep Kandregula, Jaypalsinh Gohil |
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| Rok vydání: | 2021 |
| Předmět: |
Adenoma
Adult Male Natural Orifice Endoscopic Surgery medicine.medical_specialty Adolescent Ventriculoperitoneal Shunt Neurosurgical Procedures Young Adult Pituitary adenoma medicine.artery Cerebrospinal fluid diversion medicine Anterior cerebral artery Humans Pituitary Neoplasms Retrospective Studies Third Ventricle Third ventricle business.industry Cerebral Arteries Middle Aged medicine.disease Surgery Cerebrospinal Fluid Rhinorrhea Hydrocephalus medicine.anatomical_structure Cavernous sinus Hemianopsia Female Neurology (clinical) Nasal Cavity business External ventricular drain Follow-Up Studies |
| Zdroj: | World neurosurgery. 154 |
| ISSN: | 1878-8769 |
| Popis: | Background Pituitary macroadenomas occasionally disrupt the sellae diaphragma and extend directly to the third ventricle causing hydrocephalus. We present the results of a single-stage extended endoscopic approach for managing giant pituitary adenomas (GPAs) occupying the entire third ventricle. Methods A retrospective study of all GPAs occupying the entire third ventricle operated on via the endoscopic endonasal approach between January 2016 and December 2020 was performed. Results The study included 8 cases of GPA occupying the entire third ventricle, of which 2 (25%) were functioning adenomas. Of 8 patients, 4 (50%) presented with hydrocephalus, 2 underwent preoperative ventriculoperitoneal shunt, and 2 had an intraoperative external ventricular drain. No patients had postoperative cerebrospinal fluid rhinorrhea. Complete resection of the third ventricular component could be achieved in all cases radiologically; minimal residual tumor was present either in the lateral compartment of the cavernous sinus or over the anterior cerebral artery complex in 5 of 8 (62.5%) patients. Complete resolution of temporal hemianopia was seen in 8 of the 12 eyes (66.67%), and partial resolution was seen in 4 of 12 (33.3%) eyes. At a mean follow-up of 24.62 ± 10.01 months, none of the patients needed another surgical procedure. Conclusions The extended endonasal endoscopic approach can be safely and efficiently used for single-stage excision of GPAs that disrupt the diaphragm and occupy the third ventricle. Preoperative cerebrospinal fluid diversion may be used to manage associated acute hydrocephalus in these cases. |
| Databáze: | OpenAIRE |
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