A Purely Endoscopic and Simultaneous Transsphenoidal and Transcranial Keyhole Approach for Giant Pituitary Adenoma Resection: A Technical Case Report

Takeuchi, Kazuhito; Nagatani, Tetsuya; Watanabe, Tadashi; Okumura, Eriko; Sato, Yusuke; Wakabayashi, Toshihiko

doi:10.2176/nmccrj.cr.2014-0335

Cited by 8 publications

(3 citation statements)

References 22 publications

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“…In endoscopic transsphenoidal surgery, it is difficult to remove tumors that have extended to the suprasellar area, ventricles, or cavernous sinus, and there is also a possibility of postoperative bleeding from residual tumors. It has been reported that simultaneous surgery is preferable because it may be possible to remove Simultaneous surgery with a transsphenoidal approach includes microscopic surgery, [4,8,16] transcranial surgery with a rigid endoscope, [6,11,13] and use of a tubular retractor [3,16] that have been reported. However, even among giant pituitary adenomas, prolactinomas are treated differently from the other giant pituitary adenomas.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that simultaneous surgery is preferable because it may be possible to remove the tumor by adding craniotomy to transsphenoidal surgery. Simultaneous surgery with a transsphenoidal approach includes microscopic surgery,[ 4 , 8 , 16 ] transcranial surgery with a rigid endoscope,[ 6 , 11 , 13 ] and use of a tubular retractor[ 3 , 16 ] that have been reported. However, even among giant pituitary adenomas, prolactinomas are treated differently from the other giant pituitary adenomas.…”

Section: Discussionmentioning

confidence: 99%

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A case of acute hydrocephalus due to a giant prolactinoma rescued by transventricular neuroendoscopic tumorectomy

Iwamura¹,

Nonaka²,

Li³

et al. 2023

Surgical Neurology International

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Background: A giant prolactinoma extending to the suprasellar area and causing hydrocephalus may be life-threatening and should be treated promptly. A case of a giant prolactinoma with acute hydrocephalus that underwent transventricular neuroendoscopic tumor resection followed by cabergoline administration is presented. Case Description: A 21-year-old man had a headache lasting for about a month. He gradually developed nausea and disturbance of consciousness. Magnetic resonance imaging showed a contrast-enhanced lesion that extended from the intrasellar space to the suprasellar space and into the third ventricle. The tumor obstructed the foramen of Monro and caused hydrocephalus. A blood test showed marked elevation of prolactin (16,790 ng/mL). The tumor was diagnosed as a prolactinoma. The tumor in the third ventricle had formed a cyst, and the cyst wall blocked the right foramen of Monro. The cystic component of the tumor was resected using an Olympus VEF-V flexible neuroendoscope. The histological diagnosis was pituitary adenoma. The hydrocephalus improved rapidly and his consciousness became clear. After the operation, he was started on cabergoline. The tumor size subsequently decreased. Conclusion: Prompt partial resection of the giant prolactinoma by transventricular neuroendoscopy resulted in early improvement of hydrocephalus with less invasiveness, allowing subsequent treatment with cabergoline.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A case of acute hydrocephalus due to a giant prolactinoma rescued by transventricular neuroendoscopic tumorectomy

Iwamura¹,

Nonaka²,

Li³

et al. 2023

Surgical Neurology International

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show abstract

“…The transventricular approach for the third ventricle has been reported in nine cases. [6][7][8][9][10][11][12][13][14][15][19][20][21][22][23][24] Among them, four cases are described in detail: three transforaminal approaches and one transchoroidal approach (Table 1). [12][13][14][15] Although both the transforaminal and transchoroidal approaches are commonly used for tumors of the third ventricle, 16,[25][26][27] they have limitations in directly observing tumors in the anterior part of the third ventricle.…”

Section: Discussionmentioning

confidence: 99%

Transventricular Preforniceal Approach Combined with Endoscopic Transnasal Surgery for a Giant Pituitary Adenoma: A Case Report and Literature Review

Matsumoto

Ono

ONODERA

et al. 2021

NMC Case Report Journal

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Giant pituitary adenomas carry significant surgical risks when treated with transsphenoidal approaches or the transcranial approach alone. Combined transsphenoidal and transcranial approaches have been reported; however, removing adenomas extending into the third ventricle may still be challenging. We report a case of giant pituitary adenoma expanding into the third ventricle, which was removed using a combined transventricular preforniceal approach and an endoscopic endonasal transsphenoidal surgery (ETSS). A 41-year-old man with headache, nausea, and a 1-week history of a visual field defect was transferred to our hospital. He had a disturbed left visual acuity, right homonymous hemianopia, and choked disc in both eyes. Preoperative magnetic resonance imaging revealed a giant pituitary adenoma with a maximum diameter of 55 mm extending from the intrasellar to the suprasellar region, thus occupying the entire third ventricle and causing hydrocephalus. The space between the anterior commissure and the fornix was expanded. The foramen of Monro was shifted backward due to compression by the tumor. He underwent maximum surgical resection using a combined transventricular preforniceal approach and ETSS. Considering technical demands and reliability, the intra- to suprasellar parts were removed by ETSS while the intraventricular part was removed through the preforniceal approach. The residual tumor in the right cavernous sinus and behind the anterior communicating artery was treated with stereotactic radiotherapy. One year after the operation, the patient leads an independent life. The combined technique of the preforniceal approach and ETSS provided a direct view of the entire third ventricle and hemostasis in the present case.

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Giant Pituitary Adenoma – Special Considerations

Tang

Hsueh

Eloy

et al. 2022

Otolaryngologic Clinics of North America

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A Purely Endoscopic and Simultaneous Transsphenoidal and Transcranial Keyhole Approach for Giant Pituitary Adenoma Resection: A Technical Case Report

Cited by 8 publications

References 22 publications

A case of acute hydrocephalus due to a giant prolactinoma rescued by transventricular neuroendoscopic tumorectomy

A case of acute hydrocephalus due to a giant prolactinoma rescued by transventricular neuroendoscopic tumorectomy

Transventricular Preforniceal Approach Combined with Endoscopic Transnasal Surgery for a Giant Pituitary Adenoma: A Case Report and Literature Review

Giant Pituitary Adenoma – Special Considerations

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