Anterior interhemispheric approach for removing large sellar region tumor

Abstract

The aim of the study was to explore anterior interhemispheric approach microsurgery for removing large sellar region tumors.A total of 118 patients with large sellar region tumors were treated with the anterior interhemispheric approach microsurgery. There were 58 craniopharyngioma, 37 pituitary adenoma, 5 hypothalamic glioma, 7 meningioma, and 11 other tumors cases. The maximal tumor diameter ranged from 3.0 to 8.2 cm, with a mean diameter of 4.3 cm. Diabetes insipidus and fluid and electrolyte imbalance were timely controlled after surgery. Postoperative examination of endocrine and of magnetic resonance imaging (MRI) enhancement scanning of the head were performed.Total, subtotal, and partial removal of tumors was, respectively, achieved in 80, 23, and 15 cases. A total of 109 patients had improved vision after surgery. During the hospital stay, 81 had diabetes insipidus, 68 had fluid and electrolyte imbalance, and 9 had hemorrhage and tumidness in the right frontal lobe (3 had frontal lobe contusion, and 6 had frontal lobe hematoma). The postoperative follow-up visit lasted for 3 to 105 months. During the follow-up period, 14 patients had recurrence of tumors, 38 cases had their single or multiple pituitary axis treated with hormonal replacement therapy for a long time after surgery, and 23 cases had to orally take drugs for the purpose of controlling diabetes insipidus.The anterior interhemispheric approach microsurgery is feasible for removing large sellar region tumors without significant sequels. Active postoperative managements of diabetes insipidus and fluid and electrolyte imbalance may help patients with earlier recovery.

Figure 1

Preoperative MRI (A, axial view; B, sagittal view; C, coronal view) reveals sellar region meningiomas, which are resected through anterior interhemispheric approach. One month after surgery MRI reexamination shows total removal of tumors (D, axial view; E, satittal view; F, coronal view) (A small lattice in the scale bar represented 1 cm).

Figure 2

Preoperative MRI (A, axial view; B, sagittal view; C, coronal view) displays giant pituitary adenomas which are incised through anterior interhemispheric approach with the assistance of magnetic resonance navigation and navigation screenshots (D, axial view; E, satittal view; F, coronal view) during surgery. One month after surgery MRI reexamination demonstrates total removal of tumors (G, axial view; H, satittal view; I, coronal view) (A small lattice in the scale bar represented 1 cm).

Figure 3

Preoperative MRI (A, axial view; B, sagittal view; C, coronal view) indicates giant craniopharyngiomas, which are removed through anterior interhemispheric approach. Three months after surgery MRI reexamination displays total removal of tumors (D, axial view; E, satittal view; F, coronal view) (A small lattice in the scale bar represented 1 cm).