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Endoscopic endonasal resection of a synchronous pituitary adenoma and a tuberculum sellae meningioma: technical case report.

Prevedello DM, Thomas A, Gardner P, Snyderman CH, Carrau RL, Kassam AB

Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

OBJECTIVE: The presence of a sellar macroadenoma with a concomitant tuberculum sellae meningioma typically requires a craniotomy for extirpation of the meningioma. We describe a single endoscopic approach for resection of both lesions. PRESENTATION: A 52-year-old woman with complaints of continuous headache and right temporal visual field loss was found to have a 1.9 x 2.1 x 1.7-cm enhancing sellar mass on magnetic resonance imaging scans associated with a second enhancing extra-axial lesion at the planum sphenoidale measuring 1.0 x 0.6 cm and encroaching on the right optic nerve. INTERVENTION: After the endoscopic transnasal resection of the pituitary tumor, the planum sphenoidale was drilled and the underlying dura was incised. The suprasellar tumor was identified and completely resected. Histological evaluation confirmed the concomitant presence of a meningioma and pituitary adenoma. CONCLUSION: With advances in endoscopic and image-guidance technology and increasing understanding of the endoscopic anatomy of the sellar region, surgeons are capable of reaching both intrasellar and suprasellar/anterior cranial base region tumors through a single endoscopic approach. The use of endoscopes in transsphenoidal approaches may obviate the need for additional craniotomies in properly selected patients.

Published 6 April 2007 in Neurosurgery, 60(4): E401; discussion E401.
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