Endoscopic Endonasal Approach to Multilobular Giant Pituitary Adenoma with Cavernous Sinus Invasion and Petroclival Extension

Giant pituitary adenomas are considered as a surgical challenge. Their invasiveness, irregular growth, and extensions make this surgery even critical. Because of this reason radical resection rate is low in such pathology. Endoscopic endonasal approach push their limits to get successful results in skull base lesions. Irregular shape, cavernous sinus invasion, and extensions are being successfully resected during the last decades. Lateral extension especially posterolateral extension of this tumor makes them impossible to radical resection. In this video case, we try to present an expanded endonasal approach to the irregular giant pituitary adenoma with 360-degree cavernous sinus invasion and petroclival extension of the tumor.

We are presenting an irregular shape giant pituitary adenoma case who underwent expanded endonasal approach for this reason. This is a 27-year-old male patient admitted with right sided ophthalmoplegia and visual deterioration mainly in left eye. Multilobular giant pituitary adenoma with right cavernous sinus involvement presented on MRI. Right ICA encased 360-degree with the tumor. Tumor extends to the petroclival region on the right side and compress the brainstem. Anteriorly tumor extends to the gyrus rectus and compress the left optic nerve.

Patient operated by expanded endoscopic endonasal approach. There was no intraoperative or postoperative complication.

Postoperative first day MRI shows near-total removal of the tumor. Patient did well after surgery. He had no hypopituitarism and DI after the surgery. CSF leak did not observed. Unfortunately, oculomotor palsy did not improve after surgery.

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Publication History

Article published online:
12 February 2021