Resection of giant invasive pituitary tumors through a transfacial approach: technical case report

Giant invasive pituitary adenomas are rare tumors that have been reported to extensively involve the cranial base, as well as other intra- and extra-cranial structures, making surgical resection by traditional approaches impossible. We report two cases, each of a giant invasive adenoma involving the...

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Bibliographic Details
Published inNeurosurgery Vol. 37; no. 3; p. 541
Main Authors Anson, J A, Segal, M N, Baldwin, N G, Neal, D
Format Journal Article
LanguageEnglish
Published United States 01.09.1995
Subjects
Adenoma - diagnosis
Adenoma - pathology
Adenoma - surgery
Craniotomy - methods
Follow-Up Studies
Humans
Hypophysectomy - methods
Magnetic Resonance Imaging
Male
Middle Aged
Neurologic Examination
Paraneoplastic Endocrine Syndromes - diagnosis
Paraneoplastic Endocrine Syndromes - pathology
Paraneoplastic Endocrine Syndromes - surgery
Pituitary Neoplasms - diagnosis
Pituitary Neoplasms - pathology
Pituitary Neoplasms - surgery
Postoperative Complications - diagnosis
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Summary:Giant invasive pituitary adenomas are rare tumors that have been reported to extensively involve the cranial base, as well as other intra- and extra-cranial structures, making surgical resection by traditional approaches impossible. We report two cases, each of a giant invasive adenoma involving the entire length of the clivus and adjacent structures that was resected via a transfacial approach with excellent results. Both tumors were in middle-aged men; one was nonsecreting, and the other secreted follicle-stimulating hormone alpha-subunit. Most previously reported giant invasive adenomas have been prolactinomas. Both tumors were resected via a transfacial approach that incorporated an osteoplastic maxillotomy with palatal division and a posterior pharyngeal incision that provided exposure from the suprasellar region to C2. Both of the patients received postoperative radiation and have done very well. Their cosmetic results were excellent. The complications included postoperative meningitis in one patient and a nasal voice in the other. The transfacial approach provides excellent access for this type of extensive midline tumor requiring resection from the suprasellar region down to the foramen magnum.
ISSN:0148-396X
DOI:10.1097/00006123-199509000-00029