The Anterolateral Approach for the Transcranial Resection of Pituitary Adenomas: Technical Note

ABSTRACT

We sought to quantify the mean surface area of the exposed diaphragma sellae and the mean sellar volume in the subfrontal and anterolateral approaches to pituitary adenomas and to detail our expansion of the superficial and deep window in the anterolateral approach. We performed a retrospective data analysis and cadaveric study in a clinical and skull base laboratory. We studied eight patients who had anterolateral approach for transcranial resection of pituitary macroadenoma and seven cadaveric specimens. Main outcome measures were degree of tumor resection, cerebrospinal fluid (CSF) leak, cranial nerve outcome, and quantification of the exposed sella via the anterior (subfrontal) and anterolateral approach. We observed complete resection in one; visual outcome: stable in three, improved in four, worsened in one; CSF leakage in two; transient CN III palsy in three; mean surface area (mm²) of exposed diaphragma sellae,115.3 (subfrontal approach) versus 94.7 (anterolateral approach; p = 0.1); mean sellar volume (mm³) exposed, 224.8 (subfrontal approach) versus 569.3 (anterolateral approach; p < 0.0001). Our technical note supports the increased exposure of sellar volume via the anterolateral approach. Despite the relatively high complication rate, complex cranial surgeons should maintain the skills and knowledge of transcranial approaches. Indeed, the rapid expansion of transsphenoidal techniques will continue to decrease the number of cases but will also continue to increase the complexity of those adenomas that are referred for transcranial resection.

Pituitary - transcranial - FTOZ - tumor - sella turcica

REFERENCES

• 1 Youssef A S, Agazzi S, van Loveren H R. Transcranial surgery for pituitary adenomas.  Neurosurgery. 2005;  57(1 Suppl) 168-175 discussion 168-175
• 2 Landolt A M. History of pituitary surgery from the technical aspect.  Neurosurg Clin N Am. 2001;  12 37-44 vii-viii
• 3 Pollock J R, Akinwunmi J, Scaravilli F, Powell M P. Transcranial surgery for pituitary tumors performed by Sir Victor Horsley.  Neurosurgery. 2003;  52 914-925 discussion 925-926
• 4 Symon L, Jakubowski J. Transcranial management of pituitary tumours with suprasellar extension.  J Neurol Neurosurg Psychiatry. 1979;  42 123-133
• 5 Symon L, Jakubowski J, Kendall B. Surgical treatment of giant pituitary adenomas.  J Neurol Neurosurg Psychiatry. 1979;  42 973-982
• 6 Valtonen S, Myllymäki K. Outcome of patients after transcranial operation for pituitary adenoma.  Ann Clin Res. 1986;  18(Suppl 47) 43-45
• 7 Dolenc V V. Transcranial epidural approach to pituitary tumors extending beyond the sella.  Neurosurgery. 1997;  41 542-550 discussion 551-552