Author/Editor		Bošnjak, Roman; Podboj, Jernej; Boršoš, Imre; Benedičič, Mitja
Title		Combined endoscopic and microscopic transnasal approach for removal of large pituitary macroadenomas extending to paranasal sinuses
Translated title		Kombinirani endoskopsko-mikroskopski transnazalni pristop za odstranitev velikih hipofiznih makroadenomov s širjenjem v obnosne votline
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 14, št. 30
Publication year		2009
Volume		str. 17-22
Language		eng
Abstract		Introduction. Removal of large pituitary macroadenomas with extrasellar extension to paranasal sinuses is a challenging field of skull base surgery that neccesiates cooperation between a neurosurgeon and arinologist. Combined endoscopic and microscopic transnasal approach extends the classic exposure via the transsphenoidal approach for intra-and suprasellar macroadenomas and gains added exposure of the parasellar, ethmoid and clival regions. Methods and Patients. Three patients with large nonsecretory intra-extracranial macroadenomas and panhypopituitarism were operated on by combined microscopic and endoscopic approach. In all cases intranasal, intraethmoid and intrasphenoid parts of macroadenoma were removed first by endoscopic technique followed by microscopic technique of removal of the intrasellar, suprasellar and parasellar parts of the tumor. One patient had a previous transcranial surgery four years ago. Other two patients had tumors of similar large size, but underwent only one-staged transnasal surgery. Results. In all cases, the tumor was gross-totally removed from all extrasellar parts, except from parasellar space where incomplete removal was revealed by postoperative MRI scan. Visual symptoms were improved in all patients. Intraoperative CSF leak occured in one patient and was succesfully treated by lumbar drainage. She also had a mild transient diabetes insipidus. There were no additional neurological deficits and no rhinological problems.
Descriptors		PITUITARY NEOPLASMS ADENOMA ENDOSCOPY MICROSURGERY SPHENOID BONE MIDDLE AGE NASAL CAVITY PARANASAL SINUS NEOPLASMS CAVERNOUS SINUS