title: An endoscopic modification of the simultaneous 'above and below' approach to large pituitary adenomas.
abstract: Surgical resections of large-to-giant pituitary adenomas (PA) are technically challenging procedures. Tumors with a fibrous consistency or 'hour-glass' configurations are particularly difficult to remove completely and safely through the transsphenoidal route alone. Although the transcranial approach can facilitate the removal of a large suprasellar mass, it may be associated with significant bleeding within the intradural space. A simultaneous microscopic transcranial and transsphenoidal approach has been described as an alternative surgical strategy. We have further modified this 'above and below' approach by adopting endoscopic techniques for the transsphenoidal part of the procedure. This modified approach has the advantages of requiring only one operating microscope, and permitting freer maneuvers and easier orientation for both surgical teams. We present two patients successfully treated with this approach. Complete tumor removal was achieved and both patients achieved satisfactory functional recovery.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, People's Republic of China. gilberto@hkucc.hku.hk
authors.forename: Gilberto Ka Kit
authors.initials: GK
authors.lastname: Leung
authors.forename: Michele Mae Ann
authors.initials: MM
authors.lastname: Yuen
authors.forename: Michelle Mae Ann
authors.initials: MM
authors.lastname: Yuen
authors.forename: Wing Sun
authors.initials: WS
authors.lastname: Chow
authors.forename: Philip Yat Hang
authors.initials: PY
authors.lastname: Tse
authors.forename: Wai Man
authors.initials: WM
authors.lastname: Lui
mesh_terms: D000818:Animals; D004724:Endoscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery*