[Advanced transfacial approach to extensive sellar adenoma of the pituitary gland]

The excision of tumors of the pituitary gland is usually achieved via a transsphenoidal transnasal approach. In the past, alternative approaches were described for macroadenomas. Especially in tumors surrounding the internal carotid artery (ICA) and the optic nerve, the selection of the appropriate approach is of importance. We demonstrate the case of a second extensive relapse of a macroadenoma after primary transsphenoidal resection and radiation therapy. As the tumor enclosed both the ICA and left optic nerve, a median external approach via the upper midface was chosen. After the median skin incision and translocation of the upper parts of the nasal structure, the papyraceous lamina was removed bilaterally. The orbital tissue was laterally exposed with retractors, achieving a wide access to both carotids and optic nerves. The functional and aesthetic results were satisfactory. Compared with other approaches, this one provides a good exposure of both the ICA and optic nerve.