Safety and efficacy of the direct endonasal transsphenoidal approach for challenging sellar tumors.
BACKGROUND
The direct endonasal approach to pituitary microadenomas is relatively atraumatic, rapid, and carries a lower complication rate than the sublabial approach. Large macroadenomas (3-4 cm) can still be addressed with this simple, unmodified direct endonasal approach. We present our experience with this unique and challenging patient population.


METHODS
About 64 consecutive patients with large (3-4 cm) pituitary adenomas and craniopharyngiomas were treated by the senior author (SK) using the direct endonasal approach from May 2001 to July 2004. The hospital course, endocrinological function, radiographic imaging, and outpatient follow-up were retrospectively reviewed for each patient.


RESULTS
The mean volume of these lesions was 31.5 cm(3) (range, 10.3-168 cm(3)). Tumor pathologies included 2 craniopharyngiomas, 16 functional, and 46 nonfunctional pituitary adenomas. Suprasellar extension of tumor was evident in all patients and 10 had cavernous sinus invasion. Gross total resection was achieved in 30 patients, near-gross total in 6 patients, and subtotal resection in 26 patients. Eight patients (12.5%) demonstrated postoperative complications, with diabetes insipidus for less than 1 year (n = 4) being the most common. There was no incidence of CSF leak, new panhypopituitarism, or worsened vision. Five patients (7.8%) had tumor residual requiring radiation therapy. Additionally, after a mean clinical follow-up of 24.5 months, 4 patients (6.3%) demonstrated recurrent disease.


CONCLUSIONS
Direct endonasal transsphenoidal surgery enables safe and effective resection of large sellar masses while maintaining a favorable morbidity profile.
Sanai
Nader
N
Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, M-779, P.O. Box 0112, San Francisco, CA 94143, USA. sanain@neurosurg.ucsf.edu
Quiñones-Hinojosa
Alfredo
A
Narvid
Jared
J
Kunwar
Sandeep
S
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010911:Pituitary Neoplasms / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D012658:Sella Turcica / Q000601:surgery*; D013101:Sphenoid Sinus / Q000601:surgery; D016896:Treatment Outcome