Combined Subfrontal Pterional And Transventricular Resection Of Giant Pituitary Adenoma Developed On The Saddle

Objective: To investigate the surgical approach,surgical technique and advantages of giant pituitary adenoma developed on the saddle with a combination of subfrontal pterional and transventricular resection.Methods: A retrospective analysis of 18 cases of giant pituitary adenoma patients admitted to the Department of neurosurgery,the First Hospital of Jilin University from September 2016 to December 2018.All patients were diagnosed preoperatively and combined subfrontal pterional and transventricular resection and MRI was performed 3 to 6 months after surgery.Results: In this group of 18 cases,15 cases(15/18,83.3%)were completely cut,and 3 cases(3/18,16.7%)were mostly resected.Among the cases of major resection,2 cases had residual tumors in the saddle.One patient had a close adhesion to the hypothalamus and adjacent vascular nerves.All three patients were treated with radiotherapy.Conclusion: For giant pituitary adenoma,we evaluate the patient's preoperative imaging examination,preoperative and intraoperative techniques such as neuronavigation and intraoperative MRI to determine the location,adjacent relationship and growth direction of the tumor,and consider the purpose of the operation,the surgeon's experience and preferences,choose the appropriate surgical approach.Among them,GPA is a vertical axis growth type,that is,the tumor high diameter> wide diameter,which is equivalent to the saddle-optical cross-intraventricular type,and most patients have obstructive hydrocephalus.It is an ideal and safe and effective surgical approach to select the combined subfrontal pterional and ventricle transection to remove such giant pituitary adenoma developed on the saddle.During the operation,the natural space is used to fully reveal the key surgical sites such as the optic chiasm,the pituitary stalk and the bottom of the third ventricle.During the operation,the relationship between the tumor and the hypothalamic pituitary system is carefully distinguished,and the adhesion between the tumor and the important structure is sharply separated.Surgical techniques are the key to successful treatment.