title: [A Single-Stage Combined Supra- and Infra-Sellar Approach for Recurrent Large Pituitary Adenomas:Report of Two Cases].
abstract: Despite the recent technological advances in operative instruments and development of novel techniques for endoscopic skull-base surgeries, surgical treatment of primary or recurrent large/giant pituitary adenomas remains a challenge. Postoperative hemorrhage from the residual tumor and the associated impairment of the adjacent cranial nerve functions can cause severe morbidity. To manage such operative risks, a combined supra- and infra-sellar approach(CSISA)can be used as a surgical option for difficult-to-resect large/giant pituitary adenomas. We successfully performed a single-stage CSISA in two patients with large recurrent pituitary adenomas with favorable outcomes. Both patients had recurrent adenomas after multiple trans-sphenoidal surgeries and presented with visual impairment due to tumor regrowth. Each tumor had a maximum diameter of more than 4 cm. One tumor extended into the anterior skull base, while the other extended into the supra-sellar region with extremely lateral invasion. The CSISA helped surgeons visualize the tumors and the surrounding structures through a combination of different operative views. Subtotal resection was safely achieved in both cases, with no postoperative hemorrhage and deterioration of visual and pituitary function. The CSISA is useful not only for pituitary adenomas with anterior or lateral extension and multi-lobular growth, but also for certain cases with recurrent large/giant pituitary adenomas.
authors.affiliation: Department of Neurosurgery, Tazuke Kofukai Foundation Medical Research Institute, Kitano Hospital.
authors.forename: Naokado
authors.initials: N
authors.lastname: Ikeda
authors.forename: Hiroki
authors.initials: H
authors.lastname: Toda
authors.forename: Hirokuni
authors.initials: H
authors.lastname: Hashikata
authors.forename: Namiko
authors.initials: N
authors.lastname: Nishida
authors.forename: Koichi
authors.initials: K
authors.lastname: Iwasaki
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D044583:Neuroendoscopy; D019635:Neurosurgical Procedures / Q000379:methods; D010911:Pituitary Neoplasms / Q000601:surgery*; D019291:Skull Base / Q000601:surgery*; D016896:Treatment Outcome