Intradural Pituitary Hemitransposition: Technical Note and Case Series Illustration

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Endoscopic Techniques

Background:

• Retrosellar, interpeduncular, and petroclival lesions present significant neurosurgical access challenges.
• Transcranial approaches may be limited by distance and surrounding neurovascular structures.
• A midline transsphenoidal route offers direct access, but requires pituitary gland mobilization.

Purpose of the Study:

• To describe the intradural pituitary hemitransposition technique for skull base tumor resection.
• To demonstrate the safety and efficacy of this approach in accessing the retrosellar space.
• To evaluate the preservation of pituitary function using this method.

Main Methods:

• The intradural pituitary hemitransposition technique was detailed.
• Surgical application was illustrated in 5 cases of skull base tumors.
• Advantages and limitations were compared to alternative approaches.

Main Results:

• The technique was successfully applied to resect various skull base tumors including chondrosarcoma, chordoma, craniopharyngioma, teratoma, and meningioma.
• Endocrine morbidity was minimized, with only one patient experiencing mild, permanent hyperprolactinemia and hypothyroidism.
• No other patients experienced permanent pituitary dysfunction post-surgery.

Conclusions:

• Endoscopic endonasal intradural pituitary hemitransposition is effective for retrosellar and petroclival lesions.
• This approach provides adequate surgical exposure.
• It offers potential for optimal preservation of pituitary function.