J Neurol Surg A Cent Eur Neurosurg 2012; 73 - A005
DOI: 10.1055/s-0032-1316189

Extended Endoscopic Transplanum-Transtuberculum Approach for Pituitary Adenomas

S. A. Barazi 1, E. Pasquini 3, P.I. D’Urso 1, M. Zoli 2, D. Mazzatenta 1, V. Sciarretta 3, G. Frank 2
  • 1Department of Neurosurgery, King’s College Hospital, London, United Kingdom
  • 2Department of Neurosurgery, Bellaria Hospital, Bologna, Italy
  • 3ENT Department, Sant’Orsola Malpighi Hospital, Bologna, Italy

Background: Few pituitary adenomas require removal through a transcranial route. This may be associated with more significant morbidity and mortality, compared to the transsphenoidal approach. An endoscopic extended-transplanum-transtuberculum approach (ETTA) in selected pituitary adenomas may offer an alternative to the transcranial route.

Aim: We describe our technique and experience of ETTA in pituitary adenomas of over 10 years.

Methods: Between 2005 and 2010, we performed 700 endoscopic endonasal procedures for pituitary adenomas. There were 19 patients (13 men; mean age, 48 years; range, 22 to 76 years) who underwent 22 ETTAs. Of these 19 patients, 13 had nonfunctioning adenomas. Three tumor groups were identified: (1) tumors developing in or around the pituitary stalk; (2) tumors with subfrontal extension; (3) tumors with a major extrasellar component. Mean follow-up period was 37 months (range 6 to 72 months).

Results: Gross total resection was achieved in 11 procedures (no recurrences), with partial tumor resection in 11 procedures. Of the 12 patients with visual symptoms, 10 improved. Of eight patients with hormonal hypersecretion four were cured. Complications included cerebrospinal fluid leak (14%), hemorrhage (9%), and hemiplegia (5%). Complications causing permanent morbidity occurred in 10% of cases. There were no cases of mortality.

Conclusion: Experience using the ETTA for pituitary adenomas is limited because it is indicated in highly selected cases (3.1% of our series). An absolute indication is represented by ectopic secreting pituitary stalk/peristalk adenomas. ETTA is a useful option in midline frontal adenomas and adenomas with a major extrasellar component, but has a higher morbidity than that seen in the standard transsphenoidal approach. A study comparing ETTA versus transcranial resection is highly desirable.

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3 Kassam AB, et al. J Neurosurg 2008;108:715–728

4 Frank GJ, et al. Neurosurgery 2006;59:ONS75–83