Turkish Neurosurgery 2015 , Vol 25 , Num 3
Extended Endoscopic Endonasal Surgery Using Three-Dimensional Endoscopy in the Intra-Operative Mrř Suite for Supra-Diaphragmatic Ectopic Pituitary Adenoma
Komatsu FUMINARI1, Atsumi HIDEKI2, Osakabe MANABU2, Matsumae MITSUNORI2
1Tokai University, Hachioji Hospital, Department of Neurosurgery, Hachioji, Japan
2Tokai University, Department of Neurosurgery, Isehara, Japan
DOI : 10.5137/1019-5149.JTN.11212-14.1 We describe a supra-diaphragmatic ectopic pituitary adenoma that was safely removed using the extended endoscopic endonasal approach, and discuss the value of three-dimensional (3D) endoscopy and intra-operative magnetic resonance imaging (MRI) to this type of procedure.

A 61-year-old-man with bitemporal hemianopsia was referred to our hospital, where MRI revealed an enhanced suprasellar tumor compressing the optic chiasma. The tumor extended on the planum sphenoidale and partially encased the right internal carotid artery. An endocrinological assessment indicated normal pituitary function. The extended endoscopic endonasal approach was taken using a 3D endoscope in the intraoperative MRI suite. The tumor was located above the diaphragma sellae and separated from the normal pituitary gland. The pathological findings indicated non-functioning pituitary adenoma and thus the tumor was diagnosed as a supra-diaphragmatic ectopic pituitary adenoma. Intra-operative MRI provided useful information to minimize dural opening and the supra-diaphragmatic ectopic pituitary adenoma was removed from the complex neurovascular structure via the extended endoscopic endonasal approach under 3D endoscopic guidance in the intra-operative suite. Safe and effective removal of a supra-diaphragmatic ectopic pituitary adenoma was accomplished via the extended endoscopic endonasal approach with visual information provided by 3D endoscopy and intra-operative MRI. Keywords : Chiasmatic cistern, Intraoperative MRI, Suprasellar tumor, Tuberculum sellae

Corresponding author : Fuminari Komatsu, fuminarikomatsu@gmail.com