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Federica Penner, Giuseppe Di Perna, Bianca Maria Baldassarre, Diego Garbossa, Francesco Zenga
  1. Department of Neuroscience, Neurosurgery Unit, AOC Città Della Scienza e Della Salute, Turin, Italy.

Correspondence Address:
Giuseppe Di Perna, Department of Neuroscience, Neurosurgery Unit, AOC Città Della Scienza e Della Salute, Turin, Italy.

DOI:10.25259/SNI_630_2021

Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Federica Penner, Giuseppe Di Perna, Bianca Maria Baldassarre, Diego Garbossa, Francesco Zenga. Endoscopic resection of supergiant pituitary adenoma. 25-Oct-2021;12:535

How to cite this URL: Federica Penner, Giuseppe Di Perna, Bianca Maria Baldassarre, Diego Garbossa, Francesco Zenga. Endoscopic resection of supergiant pituitary adenoma. 25-Oct-2021;12:535. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=11204

Date of Submission
24-Jun-2021

Date of Acceptance
17-Sep-2021

Date of Web Publication
25-Oct-2021

Abstract

Background: Giant pituitary adenomas are a rare finding and the literature is inconclusive regarding the most appropriate approach. In supergiant adenomas, where the size of the tumor is exceptional, both a combine approach versus a solely transcranial or endoscopic approach have been reported.[2,3,5]

Case Description: In this video, an entirely endoscopic resection of a supergiant pituitary adenoma is demonstrated. The exceptional size (4.5 × 5.8 × 5.4 cm) of the tumor and the peculiarity of the anatomical relations are documented in the video. The anterior cerebral arteries, both the A1 and A2 tracts, as well as the anterior communicating arteries are shown to be posteriorly dislocated and encased by the tumor which is pealed from the arteries themselves. Furthermore, the optic nerves are decompressed and cleaned from any residual tumor. The procedure is highly technically challenging since the furthermost part of the adenoma is also the one attached to the great intracranial arteries. A 45 optic and angle instruments were used for the major part of the surgery. Considering the high risk of postoperative CSF leak, a multilayer closure with nasoseptal flap was chosen. The postoperative MRI showed a gross total resection of the lesion in the absence of any complications and no new neurological nor endocrinological deficit appeared.

Conclusion: Expanded endoscopic endonasal approach could represent a valuable way to face giant adenoma, providing a direct corridor toward the lesion and safe control of both the chiasmatic vasculature and the anterior communicating artery complex. Multilayer reconstruction is mandatory to avoid postoperative CSF leak.[1,4]

Video 1

Annotations[ 1 - 5 ]

00:07 – Clinical Presentation

00:23 – Neurological Examination

00:36 – Neuro-Imaging Findings

01:05 – Surgical Alternatives

01:28 – Surgical Positioning

01:31 – Necessary Equipment

03:29 – Tumor Debulking

05:17 – Optic Nerves Decompression

05:31 – Tumor Dissection from Anterior Cerebral Artery and Anterior Communicating Artery

06:14 – Clinical Outcome

06:25 – Disease Background

06:35 – Radiological Outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1. di Perna G, Penner F, Cofano F, De Marco R, Baldassarre BM, Portonero I. Skull base reconstruction: A question of flow? A critical analysis of 521 endoscopic endonasal surgeries. PLoS One. 2021. 16: e0245119

2. Penner F, Prencipe N, Pennacchietti V, Pacca P, Cambria V, Garbossa D. Super giant growth hormone-secreting pituitary adenoma in young woman: From ventricles to nose. World Neurosurg. 2019. 122: 544-8

3. Rahimli T, Hidayetov T, Yusifli Z, Memmedzade H, Rajabov T, Aghayev K. Endoscopic endonasal approach to giant pituitary adenomas: Surgical outcomes and review of the literature. World Neurosurg. 2021. 149: e1043-55

4. Simal-Julián JA, Miranda-Lloret P, de San Román Mena LP, Sanromán-Álvarez P, García-Piñero A, Sanchis-Martín R. Impact of multilayer vascularized reconstruction after skull base endoscopic endonasal approaches. J Neurol Surg B Skull Base. 2020. 81: 128-35

5. Tardivo V, Penner F, Garbossa D, di Perna G, Pacca P, Salvati L. Surgical management of pituitary adenomas: Does age matter?. Pituitary. 2020. 23: 92-102

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