Simultaneous Combined Supra-Infrasellar Approach for Giant/Large Multilobulated Pituitary Adenomas

BACKGROUND: Surgical treatment of few complex pituitary adenomas, mostly large/giant and multilobulated, still remains troublesome. We present our case series using a simultaneous combined supra-infrasellar approach for these tumors. METHODS: We retrospectively reviewed our 29 consecutive patients who have undergone procedures using this approach since 2004. Preoperative characteristics and surgical outcomes were reviewed. RESULTS: Total removal of the adenoma was achieved in 7 cases, subtotal removal in 21 cases, and partial removal in 1 case. Although surgical complications apart from pituitary insufficiency were noted in 12 patients, most were transient but permanent oculomotor nerve palsy and worsening of preoperative visual disturbance developed in 2 and 1 patient, respectively. CONCLUSIONS: Because these complex adenomas are not only large and invasive but also tend to lack a well-defined tumor capsule, the combined approach was effective for the accurate and safe removal by manipulating from both sides. The present single-stage approach is a viable option for these few selected patients.