CC BY-NC-ND 4.0 · J Neurol Surg B 2018; 79(S 02): S233-S234
DOI: 10.1055/s-0037-1620261
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Infrasellar Endoscopic Endonasal Approach for a Pituitary Adenoma Extending into the Third Ventricle, with Anterior Displacement of the Pituitary Gland

Georgios A. Zenonos
1  Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Eric W. Wang
2  Department of Otorhinolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Juan Carlos Fernandez-Miranda
1  Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
› Author Affiliations
Further Information

Address for correspondence

Juan Carlos Fernandez-Miranda, MD
Department of Neurosurgery, University of Pittsburgh Medical Center
200 Lothrop Street, Suite B400, Pittsburgh, PA 15213
United States   

Publication History

15 October 2017

29 November 2017

Publication Date:
16 January 2018 (eFirst)

 

    Abstract

    Objectives The current video presents the nuances of the infrasellar endoscopic endonasal approach for a pituitary adenoma extending into the third ventricle, with anterior displacement of the pituitary gland.

    Design The video analyzes the presentation, preoperative workup and imaging, surgical steps and technical nuances of the surgery, the clinical outcome, and follow-up imaging.

    Setting The patient was treated by a skull base team consisting of a neurosurgeon and an ENT surgeon at a teaching academic institution.

    Participants The case refers to 73-year-old female patient who was found to have a sellar mass after failure of vision to improve with cataract surgery. She also reported a several-month history of progressive loss of vision along with daily retro-orbital headaches. The adenoma extended into the clivus as well as in the retrosellar and suprasellar regions, eroding into the floor of the third ventricle. The normal gland was displaced anteriorly.

    Main Outcome Measures The main outcome measures consisted of reversal of patient symptoms (headaches and visual disturbance), recurrence-free survival based on imaging, as well as absence of any complications.

    Results The patient's headaches and visual fields improved. There was no evidence of recurrence.

    Conclusion The infrasellar endoscopic endonasal approach is safe and effective for pituitary adenomas extending into the third ventricle, with anterior displacement of the pituitary gland.

    The link to the video can be found at: https://youtu.be/zp_06mEyRvY.


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    Zoom Image
    Fig. 1 (A) Preoperative T2-weighted MRI image showing invasion of the floor of the 3rd ventricle. (B) Sagittal and axial contrasted images showing anterior displacement of the normal pituitary gland. (C) Visual fields preoperatively showed left temporal hemianopia. (D) Intra-operative image showing the foramina of Monroe. (E) Resection of tumor from the retrosellar region revealed the basilar bifurcation and mammillary bodies. (F) The suprasellar region was exposed to allow for superior displacement of the pituitary gland. (G) Postoperative imaging showing complete resection of the lesion.

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    Quality:

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    Conflict of Interest

    None.

    Address for correspondence

    Juan Carlos Fernandez-Miranda, MD
    Department of Neurosurgery, University of Pittsburgh Medical Center
    200 Lothrop Street, Suite B400, Pittsburgh, PA 15213
    United States   

      
    Zoom Image
    Fig. 1 (A) Preoperative T2-weighted MRI image showing invasion of the floor of the 3rd ventricle. (B) Sagittal and axial contrasted images showing anterior displacement of the normal pituitary gland. (C) Visual fields preoperatively showed left temporal hemianopia. (D) Intra-operative image showing the foramina of Monroe. (E) Resection of tumor from the retrosellar region revealed the basilar bifurcation and mammillary bodies. (F) The suprasellar region was exposed to allow for superior displacement of the pituitary gland. (G) Postoperative imaging showing complete resection of the lesion.