Journal of Neurosurgical Sciences 2020 Nov 27

DOI: 10.23736/S0390-5616.20.05120-6

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Extended endonasal approaches for pituitary adenomas

Domenico SOLARI, Elena D’AVELLA, Ilaria BOVE, Paolo CAPPABIANCA ✉, Luigi M. CAVALLO

Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli Federico II, Naples, Italy

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.

KEY WORDS: Endoscopic extended approach; Parasellar extension; Pituitary adenoma; Subarachnoid invasion; Suprasellar extension