[Endoscopic Combined Transcranial and Endonasal Approach]

Surgical treatment for massive lobulated lesions arising in the sella turcica carries various risks of complications and requires careful surgical planning. In particular, for giant pituitary neuroendocrine tumors, bleeding from residual tumor tissue poses a significant clinical challenge. We describe a combined approach using endoscopic keyhole surgery and trans nasal surgery for cases in which resection through a single corridor is difficult, such as tumors extending laterally beyond the internal carotid artery or those extensively invading the brain parenchyma or ventricles. We explain the technique, its practical application, and its variations.