Endoscopic Endonasal Approach for Resection of Infundibular Granular Cell Tumor: Case Report and Literature Review

Granular cell tumors of the pituitary and infundibular stalk are rare, slow growing tumors. Although usually asymptomatic, neurological deficits with chiasmatic compression can lead to clinical presentation. We describe a case in which a purely endoscopic endonasal approach was used for complete resection of an infundibular granular cell tumor with skull base reconstruction with a pedicled nasoseptal flap. Final pathology confirmed the diagnosis and 24 month follow up revealed no recurrence of the tumor with continued improvement in the patient's vision. This diagnosis must be entertained for masses noted in the sellar/suprasellar region. Immunohistochemistry and radiographic findings help lead to an accurate diagnosis. Complete surgical resection remains the mainstay of treatment in symptomatic patients, as published reports indicate little value with adjuvant radiation therapy and poor long term control. The complication of panhypopituitarism can often result following complete resection and patients need to be counseled with the risks of treatment. A purely endoscopic endonasal approach was safe and effective and should be attempted only by experienced skull base centers.