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Updated: May 27, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Simultaneous combined supra-infrasellar approach for giant/large multilobulated pituitary adenomas
Hiroshi Nishioka1, Takayuki Hara, Masaaki Usui
1Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, Japan. nishioka@tokyo-med.ac.jp
Background:
Surgical treatment of few complex pituitary adenomas, mostly large/giant and multilobulated, still remains troublesome. We present our case series using a simultaneous combined supra-infrasellar approach for these tumors.
Methods:
We retrospectively reviewed our 29 consecutive patients who have undergone procedures using this approach since 2004. Preoperative characteristics and surgical outcomes were reviewed.
Results:
Total removal of the adenoma was achieved in 7 cases, subtotal removal in 21 cases, and partial removal in 1 case. Although surgical complications apart from pituitary insufficiency were noted in 12 patients, most were transient but permanent oculomotor nerve palsy and worsening of preoperative visual disturbance developed in 2 and 1 patient, respectively.
Conclusions:
Because these complex adenomas are not only large and invasive but also tend to lack a well-defined tumor capsule, the combined approach was effective for the accurate and safe removal by manipulating from both sides. The present single-stage approach is a viable option for these few selected patients.
