title: Transsphenoidal removal of huge pituitary adenomas with marked suprasellar extension: results with modified surgical technique.
abstract: OBJECTIVE
  A modified transsphenoidal technique to remove huge pituitary adenomas with marked suprasellar extension (4.5-8 cm of maximum diameter) is presented.
  
  
  METHODS
  The technique allowed to avoid the occurrence of a precocious descent of the suprasellar cisternal plane into the sellar plane during tumour removal and its related consequences (incomplete tumour removal, occurrence of cerebrospinal fluid leak, prolonged time of postoperative stay in hospital). Technique is performed opening at the beginning only the lateral parts of peritumoral dura mater, leaving the central part of the dura mater in support of the central part of tumour and suprasellar cisternal plane. After removal of lateral parts of the tumour, the central part of peritumoral dura mater is opened and the central intra- and supra-sellar parts of the tumour are removed.
  
  
  RESULTS
  Total removal was accomplished in 64% and 45% in groups two and one respectively. Intraoperative CSF leak occurred in 2.4% and 22.5% respectively in groups two and one. Postoperative CSF fistula did not occur in group two, while it occurred in 7.4% of patients of group one. Average time of postoperative stay in hospital was 4.3 and 8.2 days in groups two and one respectively.
  
  
  CONCLUSIONS
  The presented modified transsphenoidal microsurgical technique for removal of huge pituitary adenomas allowed to achieve better results than patients operated by standard transsphenoidal surgery.
authors: Department of Neurosciences, Neurosurgery, University of Rome Tor Vergata, Italy. b.fraioli@libero.it
authors: Mario Francesco
authors: MF
authors: Fraioli
authors: Elisabetta
authors: E
authors: Catena
authors: Mario
authors: M
authors: Lecce
authors: Bernardo
authors: B
authors: Fraioli
mesh_terms: D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology / Q000209:etiology; D004388:Dura Mater / Q000601:surgery; D005260:Female; D005402:Fistula / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000379:methods*; D010911:Pituitary Neoplasms / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D019291:Skull Base / Q000601:surgery; D013100:Sphenoid Bone / Q000601:surgery*; D016896:Treatment Outcome