Extended endonasal approaches for pituitary adenomas.

医学 垂体腺瘤 肢端肥大症 垂体 垂体瘤 鼻内镜手术 放射科 海绵窦 垂体瘤 腺瘤 经蝶手术 蝶鞍 尿崩症
作者
Domenico Solari,Elena d'Avella,Ilaria Bove,Paolo Cappabianca,Luigi Maria Cavallo
出处
期刊:Journal of Neurosurgical Sciences [Edizioni Minerva Medica]
卷期号:65 (2): 160-168
标识
DOI:10.23736/s0390-5616.20.05120-6
摘要

Pituitary adenomas presenting with significant extension beyond the sellar boundary, large size, asymmetrical shape and subarachnoid space invasion, although rare, represent a therapeutic challenge. The invasiveness of the tumor itself often limits the potential for complete tumor resection and increases the likelihood of intraoperative or postoperative complications, regardless of the approach. The extended endoscopic endonasal approach has been proposed as a valid alternative to the transcranial route for the treatment of certain pituitary adenomas not suitable to the standard transsphenoidal approach. Thanks to the wide and close up view provided by the endoscope via the appropriate expanded bone removal at the skull base, this technique offers, in an adequate working space, a safe exposure of the tumor and surrounding anatomical structures, at the supra-, para-, and retro-sellar areas. It stands clear that the primary goal of this approach remains the maximum allowed resection with preservation of neurological and endocrine functions. Herein, we debate the extended endoscopic endonasal technique for the treatment of pituitary adenomas, with the aim of underlying its indications, pitfalls, advantages, and limitations.

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