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Updated: May 14, 2026
07:43
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Chronic encapsulated expanding hematoma in nonfunctioning pituitary adenoma
Takashi Sugawara1, Masaru Aoyagi, Youji Tanaka
1Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. sugawara.nsrg@tmd.ac.jp
Neurosurgical Review
|January 25, 2013
Summary
Pituitary macroadenomas with hematoma fluid accumulation are challenging to resect completely. Recurrent hemorrhage from granulation tissue causes these tumors, necessitating careful surgical identification of the gland boundary.
Area of Science:
- Endocrinology
- Neurosurgery
- Pathology
Background:
- Pituitary macroadenomas with significant hematoma fluid present diagnostic and therapeutic challenges.
- Complete resection is often difficult, leading to a high rate of recurrence.
Purpose of the Study:
- To investigate the histopathology of pituitary macroadenomas composed entirely of hematoma fluid.
- To clarify the mechanism of hematoma fluid accumulation in these specific lesions.
Main Methods:
- Retrospective review of five patients with pituitary adenoma and intra-tumor hematoma.
- Analysis of clinical status, magnetic resonance imaging (MRI) findings, intraoperative observations, and histopathology.
- Review of transsphenoidal resection techniques.
Main Results:
- All tumors were nonfunctioning pituitary adenomas extending to the cavernous sinus.
- Histopathology revealed tumor tissue amidst granulation tissue and pseudocapsule, with evidence of repeat hemorrhage.
- Repeat hemorrhage from granulation tissue was identified as the cause of hematoma accumulation, forming a chronic encapsulated expanding hematoma.
Conclusions:
- Hematoma fluid accumulation in pituitary macroadenomas results from recurrent bleeding from reactive granulation tissues.
- Identifying the boundary between the adenoma and normal pituitary gland before puncturing the hematoma is crucial to minimize recurrence risk.
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