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Combined supra-infrasellar approach to pituitary macroadenoma with oculomotor cistern extension: surgical strategy and experience

  • Original Article - Pituitaries
  • Published:
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Abstract

Background

Oculomotor cistern extension (OMCE) of pituitary adenoma through the oculomotor triangle may be one of the major characteristics of multi-lobulated adenoma. The OMCE may be hard to remove only through the endonasal approach.

Method

We applied the simultaneous combined supra-infrasellar approach to remove pituitary adenoma with relatively large OMCE. Four (7.3%) of 55 consecutive patients with initially operated pituitary macroadenoma (> 10 mm) had OMCE. The combined supra-infrasellar approach was adopted in two cases with relatively large OMCE.

Results

The simultaneous combined supra-infrasellar approach was performed with the transcranial microscopic transsylvian anterior temporal approach and the nasal endoscopic approach. The medial main mass was removed through the nasal side. The lateral OMCE was also removed through the nasal side by pushing the tumor in the sellar direction from the transcranial side. The oculomotor nerve was confirmed with electrical nerve stimulation. The main medial mass and the OMCE were mostly removed in both cases. Remnant tumor in the cavernous sinus was treated by gamma knife radiosurgery. Endoscopic transsphenoidal removal was performed in the other two cases with relatively small OMCE.

Conclusions

Pituitary macroadenomas with OMCE are a newly recognized form of progression with important implications for surgical strategy. The combined supra-infrasellar approach performed with the transcranial microscopic transsylvian anterior temporal approach using electrical nerve stimulation and the nasal endoscopic approach may be useful for this type of multi-lobulated pituitary adenoma.

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Abbreviations

EOG:

electrooculography

MR:

magnetic resonance

OMCE:

oculomotor cistern extension

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Funding

This study was partly supported by grants from the Ministry of Education, Science, Sports, and Culture.

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Authors and Affiliations

  1. Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Masahiko Tosaka, Tatsuya Shimizu, Takaaki Miyagishima, Yukitaka Tanaka, Tadashi Osawa, Masanori Aihara, Rei Yamaguchi & Yuhei Yoshimoto

Authors
  1. Masahiko Tosaka
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  2. Tatsuya Shimizu
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  3. Takaaki Miyagishima
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  4. Yukitaka Tanaka
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  5. Tadashi Osawa
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  6. Masanori Aihara
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  7. Rei Yamaguchi
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  8. Yuhei Yoshimoto
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Correspondence to Masahiko Tosaka.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committees of the country of each participating member and with the 1964 Helsinki declaration and its later amendments or comparable standards.

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Informed consent was obtained from all participants included in the study.

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This article is part of the Topical Collection on Pituitaries

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Tosaka, M., Shimizu, T., Miyagishima, T. et al. Combined supra-infrasellar approach to pituitary macroadenoma with oculomotor cistern extension: surgical strategy and experience. Acta Neurochir 161, 1025–1031 (2019). https://doi.org/10.1007/s00701-019-03869-6

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  • DOI: https://doi.org/10.1007/s00701-019-03869-6

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