Download PDF
CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2022; 83(S 03): e630-e631
DOI: 10.1055/s-0041-1727119
Skull Base: Operative Videos

Transcavernous Approach to the Anteromedial Triangle for Residual Functional Pituitary Adenoma

Daniele Starnoni
1   Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Switzerland
,
Giulia Cossu
1   Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Switzerland
,
Mahmoud Messerer
1   Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Switzerland
2   University of Lausanne (UniL), Lausanne, Switzerland
,
Roy Thomas Daniel
1   Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Switzerland
2   University of Lausanne (UniL), Lausanne, Switzerland
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Surgical treatment of functional pituitary adenomas is as rule performed by transsphenoidal approach. However, when then lesion invades the parasellar structures and the cavernous sinus, the transsphenoidal removal of these adenomas is usually incomplete. In this video, we present the technical nuances of a transcavernous approach to the anterio-medial triangle for the resection of a residual functional pituitary adenoma. The patient is a 40-year-old male who was diagnosed with growth hormone secreting pituitary macroadenoma. He underwent two transsphenoidal resections in 2013 and 2016 with a small residue in the left cavernous sinus. Subsequently, due to a failure of biochemical remission despite medical management, a transcranial transcavernous surgery was performed. Brain magnetic resonance imaging showed a mass in the roof of the left cavernous sinus, located at the level of the anteromedial triangle, adherent to the clinoidal segment of the internal carotid artery (ICA). The computed tomographic scan showed an osteolysis of the inferior surface of the anterior clinoidal process. After performing an extended pterional craniotomy and an extradural clinoidectomy, the cleavage plane is extended between the temporal dura and the inner layer of the lateral wall of the cavernous sinus. Intraoperative Doppler and stimulation are used to localize the clinoidal segment of the ICA and the third cranial nerve, delimiting the anteromedial triangle. The lesion is progressively dissected and removed. An optic neuropexy with the previously harvested fat is performed in case of a complementary radio surgical treatment. The patient had an uneventful postoperative course and showed a biochemical remission at the 3-month follow-up.

The link to the video can be found at: https://youtu.be/oHfugVtU-Nc.

Keywords

cavernous sinus - extradural clinoidectomy - anteromedial triangle - pituitary adenoma


Publication History

Received: 01 April 2020

Accepted: 03 November 2020

Article published online:
11 May 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany