Giant pituitary tumor combined approach

Nishioka et al. have provided a review of 29 patients with large pituitary adenomas who underwent surgery through a simultaneous transsphenoidal and transcranial approach at their institution during a 7-year period. Large adenomas with hourglass constriction, complex lobulations, and asymmetric extension were the primary indications for the simultaneous combined approach. The transcranial approaches used were the pterional approach in 17 patients, interhemispheric approach in 8, and transventricular (transcortical) approach in 4 patients. The results of the series of patients were carefully tabulated. The investigators are to be commended on their very good results with this difficult group of patients.