title: Combined endoscopic transsphenoidal-transventricular approach for resection of a giant pituitary macroadenoma.
abstract: OBJECTIVE
  Sellar lesions, such as pituitary adenomas, even when extended to the suprasellar space may be usually removed through a trans-sphenoidal approach. Larger lesions extending well beyond the edges of the sellar diaphragm such as giant adenomas are best controlled with craniotomy and/or a combined approach that implies both, transphenoidal and transcranial route. Currently, the availability of more sophisticated endoscopes in this type of surgery has provided optimal angles of view and rendered the trans-sphenoidal route less invasive yet, more effective.
  
  
  METHODS
  The authors report a case of a giant pituitary adenoma successfully managed by a simultaneous, combined endoscopic trans-sphenoidal-transventricular approach.
  
  
  CONCLUSIONS
  In selected case of giant pituitary adenoma with ventricular extension, this technique may help to achieve a gross total removal avoiding the need of staged procedures allowing also a direct visualization of the extent of removal. Finally this approach can potentially improve gross total resection rate of different types of tumor involving this region such as cranipharyngiomas while reducing morbidity and mortality.
authors.affiliation: Department of Neurosurgery, Parma University Hospital, Parma, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Romano
authors.forename: Salvatore
authors.initials: S
authors.lastname: Chibbaro
authors.forename: Marco
authors.initials: M
authors.lastname: Marsella
authors.forename: Gabriele
authors.initials: G
authors.lastname: Oretti
authors.forename: Toma
authors.initials: T
authors.lastname: Spiriev
authors.forename: Corrado
authors.initials: C
authors.lastname: Iaccarino
authors.forename: Franco
authors.initials: F
authors.lastname: Servadei
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D003919:Diabetes Insipidus / Q000209:etiology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D044583:Neuroendoscopy / Q000379:methods*; D009460:Neurologic Examination; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D013101:Sphenoid Sinus / Q000601:surgery; D014696:Ventriculostomy / Q000379:methods