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Published in: Journal of Neuro-Oncology 3/2008

01-05-2008 | Clinical Study - patient Studies

Safety and efficacy of the direct endonasal transsphenoidal approach for challenging sellar tumors

Authors: Nader Sanai, Alfredo Quiñones-Hinojosa, Jared Narvid, Sandeep Kunwar

Published in: Journal of Neuro-Oncology | Issue 3/2008

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Abstract

Introduction The direct endonasal approach to pituitary microadenomas is relatively atraumatic, rapid, and carries a lower complication rate than the sublabial approach. Large macroadenomas (3–4 cm) can still be addressed with this simple, unmodified direct endonasal approach. We present our experience with this unique and challenging patient population. Methods About 64 consecutive patients with large (3–4 cm) pituitary adenomas and craniopharyngiomas were treated by the senior author (SK) using the direct endonasal approach from May 2001 to July 2004. The hospital course, endocrinological function, radiographic imaging, and outpatient follow-up were retrospectively reviewed for each patient. Results The mean volume of these lesions was 31.5 cm3 (range, 10.3–168 cm3). Tumor pathologies included 2 craniopharyngiomas, 16 functional, and 46 nonfunctional pituitary adenomas. Suprasellar extension of tumor was evident in all patients and 10 had cavernous sinus invasion. Gross total resection was achieved in 30 patients, near-gross total in 6 patients, and subtotal resection in 26 patients. Eight patients (12.5%) demonstrated postoperative complications, with diabetes insipidus for less than 1 year (n = 4) being the most common. There was no incidence of CSF leak, new panhypopituitarism, or worsened vision. Five patients (7.8%) had tumor residual requiring radiation therapy. Additionally, after a mean clinical follow-up of 24.5 months, 4 patients (6.3%) demonstrated recurrent disease. Conclusions Direct endonasal transsphenoidal surgery enables safe and effective resection of large sellar masses while maintaining a favorable morbidity profile.
Literature
1.
2.
go back to reference Ebersold MJ, Quast LM, Laws ER Jr, Scheithauer B, Randall RV (1986) Long-term results in transsphenoidal removal of nonfunctioning pituitary adenomas. J Neurosurg 64:713–719PubMed Ebersold MJ, Quast LM, Laws ER Jr, Scheithauer B, Randall RV (1986) Long-term results in transsphenoidal removal of nonfunctioning pituitary adenomas. J Neurosurg 64:713–719PubMed
3.
go back to reference Honegger J, Fahlbusch R, Buchfelder M, Huk WJ, Thierauf P (1993) The role of transsphenoidal microsurgery in the management of sellar and parasellar meningioma. Surg Neurol 39:18–24PubMedCrossRef Honegger J, Fahlbusch R, Buchfelder M, Huk WJ, Thierauf P (1993) The role of transsphenoidal microsurgery in the management of sellar and parasellar meningioma. Surg Neurol 39:18–24PubMedCrossRef
4.
go back to reference Jane JA Jr, Thapar K, Kaptain GJ, Maartens N, Laws ER Jr (2002) Pituitary surgery: transsphenoidal approach. Neurosurgery 51:435–442; discussion 442–434PubMedCrossRef Jane JA Jr, Thapar K, Kaptain GJ, Maartens N, Laws ER Jr (2002) Pituitary surgery: transsphenoidal approach. Neurosurgery 51:435–442; discussion 442–434PubMedCrossRef
5.
go back to reference Griffith HB, Veerapen R (1987) A direct transnasal approach to the sphenoid sinus. Technical note. J Neurosurg 66:140–142PubMed Griffith HB, Veerapen R (1987) A direct transnasal approach to the sphenoid sinus. Technical note. J Neurosurg 66:140–142PubMed
6.
go back to reference Zada G, Kelly DF, Cohan P, Wang C, Swerdloff R (2003) Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions. J Neurosurg 98:350–358PubMed Zada G, Kelly DF, Cohan P, Wang C, Swerdloff R (2003) Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions. J Neurosurg 98:350–358PubMed
7.
go back to reference Liu JK, Das K, Weiss MH, Laws ER Jr, Couldwell WT (2001) The history and evolution of transsphenoidal surgery. J Neurosurg 95:1083–1096PubMed Liu JK, Das K, Weiss MH, Laws ER Jr, Couldwell WT (2001) The history and evolution of transsphenoidal surgery. J Neurosurg 95:1083–1096PubMed
8.
go back to reference Spencer WR, Levine JM, Couldwell WT, Brown-Wagner M, Moscatello A (2000) Approaches to the sellar and parasellar region: a retrospective comparison of the endonasal-transsphenoidal and sublabial-transsphenoidal approaches. Otolaryngol Head Neck Surg 122:367–369PubMedCrossRef Spencer WR, Levine JM, Couldwell WT, Brown-Wagner M, Moscatello A (2000) Approaches to the sellar and parasellar region: a retrospective comparison of the endonasal-transsphenoidal and sublabial-transsphenoidal approaches. Otolaryngol Head Neck Surg 122:367–369PubMedCrossRef
9.
go back to reference Sheehan MT, Atkinson JL, Kasperbauer JL, Erickson BJ, Nippoldt TB (1999) Preliminary comparison of the endoscopic transnasal vs the sublabial transseptal approach for clinically nonfunctioning pituitary macroadenomas. Mayo Clin Proc 74:661–670PubMed Sheehan MT, Atkinson JL, Kasperbauer JL, Erickson BJ, Nippoldt TB (1999) Preliminary comparison of the endoscopic transnasal vs the sublabial transseptal approach for clinically nonfunctioning pituitary macroadenomas. Mayo Clin Proc 74:661–670PubMed
10.
go back to reference Das K, Spencer W, Nwagwu CI, Schaeffer S, Wenk E, Weiss MH, Couldwell WT (2001) Approaches to the sellar and parasellar region: anatomic comparison of endonasal-transsphenoidal, sublabial-transsphenoidal, and transethmoidal approaches. Neurol Res 23:51–54PubMedCrossRef Das K, Spencer W, Nwagwu CI, Schaeffer S, Wenk E, Weiss MH, Couldwell WT (2001) Approaches to the sellar and parasellar region: anatomic comparison of endonasal-transsphenoidal, sublabial-transsphenoidal, and transethmoidal approaches. Neurol Res 23:51–54PubMedCrossRef
11.
go back to reference Fahlbusch R, Schott W (2002) Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg 96:235–243PubMedCrossRef Fahlbusch R, Schott W (2002) Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg 96:235–243PubMedCrossRef
12.
go back to reference Goel A, Nadkarni T, Muzumdar D, Desai K, Phalke U, Sharma P (2004) Giant pituitary tumors: a study based on surgical treatment of 118 cases. Surg Neurol 61:436–445; discussion 445–436PubMedCrossRef Goel A, Nadkarni T, Muzumdar D, Desai K, Phalke U, Sharma P (2004) Giant pituitary tumors: a study based on surgical treatment of 118 cases. Surg Neurol 61:436–445; discussion 445–436PubMedCrossRef
13.
go back to reference Alleyne CH Jr, Barrow DL, Oyesiku NM (2002) Combined transsphenoidal and pterional craniotomy approach to giant pituitary tumors. Surg Neurol 57:380–390; discussion 390PubMedCrossRef Alleyne CH Jr, Barrow DL, Oyesiku NM (2002) Combined transsphenoidal and pterional craniotomy approach to giant pituitary tumors. Surg Neurol 57:380–390; discussion 390PubMedCrossRef
14.
go back to reference Weiss MH (1987) Transnasal transsphenoidal approach. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams & Wilkens, Baltimore, pp 476–494 Weiss MH (1987) Transnasal transsphenoidal approach. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams & Wilkens, Baltimore, pp 476–494
15.
go back to reference Agrawal A, Cincu R, Goel A (2007) Current concepts and controversies in the management of non-functioning giant pituitary macroadenomas. Clin Neurol Neurosurg 109(8):645–650PubMedCrossRef Agrawal A, Cincu R, Goel A (2007) Current concepts and controversies in the management of non-functioning giant pituitary macroadenomas. Clin Neurol Neurosurg 109(8):645–650PubMedCrossRef
16.
go back to reference Dusick JR, Esposito F, Kelly DF, Cohan P, DeSalles A, Becker DP, Martin NA (2005) The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors. J Neurosurg 102:832–841PubMed Dusick JR, Esposito F, Kelly DF, Cohan P, DeSalles A, Becker DP, Martin NA (2005) The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors. J Neurosurg 102:832–841PubMed
17.
go back to reference Nimsky C, von Keller B, Ganslandt O, Fahlbusch R (2006) Intraoperative high-field magnetic resonance imaging in transsphenoidal surgery of hormonally inactive pituitary macroadenomas. Neurosurgery 59:105–114; discussion 105–114PubMedCrossRef Nimsky C, von Keller B, Ganslandt O, Fahlbusch R (2006) Intraoperative high-field magnetic resonance imaging in transsphenoidal surgery of hormonally inactive pituitary macroadenomas. Neurosurgery 59:105–114; discussion 105–114PubMedCrossRef
18.
go back to reference Schwartz TH, Stieg PE, Anand VK (2006) Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging. Neurosurgery 58:S44–S51; discussion ONS44–S51CrossRef Schwartz TH, Stieg PE, Anand VK (2006) Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging. Neurosurgery 58:S44–S51; discussion ONS44–S51CrossRef
19.
go back to reference Dusick JR, Esposito F, Malkasian D, Kelly DF (2007) Avoidance of carotid artery injuries in transsphenoidal surgery with the Doppler probe and micro-hook blades. Neurosurgery 60:322–328; discussion 328–329PubMedCrossRef Dusick JR, Esposito F, Malkasian D, Kelly DF (2007) Avoidance of carotid artery injuries in transsphenoidal surgery with the Doppler probe and micro-hook blades. Neurosurgery 60:322–328; discussion 328–329PubMedCrossRef
20.
21.
go back to reference Yamasaki T, Moritake K, Nagai H, Kimura Y (2002) Integration of ultrasonography and endoscopy into transsphenoidal surgery with a “picture-in-picture” viewing system–technical note. Neurol Med Chir (Tokyo) 42:275–277; discussion 278CrossRef Yamasaki T, Moritake K, Nagai H, Kimura Y (2002) Integration of ultrasonography and endoscopy into transsphenoidal surgery with a “picture-in-picture” viewing system–technical note. Neurol Med Chir (Tokyo) 42:275–277; discussion 278CrossRef
22.
go back to reference Wilson CB (1979) Neurosurgical management of large and invasive pituitary tumors. In: Tindall GT, Collins, WF (ed) Clinical managment of pituitary disorders. Raven Press, New York, pp 335–342 Wilson CB (1979) Neurosurgical management of large and invasive pituitary tumors. In: Tindall GT, Collins, WF (ed) Clinical managment of pituitary disorders. Raven Press, New York, pp 335–342
23.
24.
go back to reference Cohen AR, Cooper PR, Kupersmith MJ, Flamm ES, Ransohoff J (1985) Visual recovery after transsphenoidal removal of pituitary adenomas. Neurosurgery 17:446–452PubMedCrossRef Cohen AR, Cooper PR, Kupersmith MJ, Flamm ES, Ransohoff J (1985) Visual recovery after transsphenoidal removal of pituitary adenomas. Neurosurgery 17:446–452PubMedCrossRef
25.
go back to reference Marazuela M, Astigarraga B, Vicente A, Estrada J, Cuerda C, Garcia-Uria J, Lucas T (1994) Recovery of visual and endocrine function following transsphenoidal surgery of large nonfunctioning pituitary adenomas. J Endocrinol Invest 17:703–707PubMed Marazuela M, Astigarraga B, Vicente A, Estrada J, Cuerda C, Garcia-Uria J, Lucas T (1994) Recovery of visual and endocrine function following transsphenoidal surgery of large nonfunctioning pituitary adenomas. J Endocrinol Invest 17:703–707PubMed
26.
go back to reference Zhang X, Li A, Yi S, Zhang Z, Fei Z, Zhang J, Fu L, Liu W, Chen Y (1998) Transsphenoidal microsurgical removal of large pituitary adenomas. Chin Med J (Engl) 111:963–967 Zhang X, Li A, Yi S, Zhang Z, Fei Z, Zhang J, Fu L, Liu W, Chen Y (1998) Transsphenoidal microsurgical removal of large pituitary adenomas. Chin Med J (Engl) 111:963–967
27.
go back to reference Kim J, Cheong J, Yi H, Bak K, Kim C, Lee S (2002) Usefulness of silicone plate for sellar floor reconstruction. Minim Invasive Neurosurg 45:124–127PubMedCrossRef Kim J, Cheong J, Yi H, Bak K, Kim C, Lee S (2002) Usefulness of silicone plate for sellar floor reconstruction. Minim Invasive Neurosurg 45:124–127PubMedCrossRef
28.
go back to reference Kitano M, Taneda M (2004) Subdural patch graft technique for watertight closure of large dural defects in extended transsphenoidal surgery. Neurosurgery 54:653–660; discussion 660–651PubMedCrossRef Kitano M, Taneda M (2004) Subdural patch graft technique for watertight closure of large dural defects in extended transsphenoidal surgery. Neurosurgery 54:653–660; discussion 660–651PubMedCrossRef
Metadata
Title
Safety and efficacy of the direct endonasal transsphenoidal approach for challenging sellar tumors
Authors
Nader Sanai
Alfredo Quiñones-Hinojosa
Jared Narvid
Sandeep Kunwar
Publication date
01-05-2008
Publisher
Springer US
Published in
Journal of Neuro-Oncology / Issue 3/2008
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI
https://doi.org/10.1007/s11060-007-9512-2

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