Combined endoscopic endonasal transsphenoidal and microscopic transcranial approaches for the primary resection of giant pituitary adenomas

Abstract

Aim

Giant pituitary adenomas often present as dumbbell-shaped or multilobulated, presenting significant challenges for surgical treatment. Currently, there is no universally recognized optimal surgical strategy for choosing a dual-scope approach for primary or staged resection. This study aims to present surgical cases and clinical experience with endoscopic endonasal transsphenoidal combined with microscopic transcranial approaches for the primary resection of giant pituitary adenomas.

Material and methods

Ten patients with giant pituitary adenomas underwent one-stage surgical resection using endoscopic endonasal transsphenoidal combined with microscopic transcranial approaches. Imaging findings and treatment outcomes were subsequently reviewed.

Results

All patients underwent single-stage tumor resection using endoscopic endonasal transsphenoidal combined with microscopic transcranial approaches. Nine patients underwent total resection, while one patient underwent near-total resection. Postoperatively, visual acuity improved in six patients, while four patients experienced no significant change in visual acuity. One patient experienced cerebrospinal fluid leakage postoperatively and underwent a second repair. One patient developed a postoperative infection, and one developed hypopituitarism. No deaths or serious complications occurred.

Conclusion

Single-stage resection of giant pituitary adenomas using endoscopic endonasal transsphenoidal combined with microscopic transcranial approaches facilitates complete tumor resection, minimizes the need for residual tumor and staged surgeries, and reduces postoperative bleeding due to tumor remnants. This method improves the total resection rate and reduces postoperative complications and mortality, demonstrating significant effects and clinical application value, making it worthy of promotion.