Effectiveness of a Modified Transsellar Approach with Planum Sphenoidale Removal for Pituitary Neuroendocrine Tumors with Anterosuperior Extension

Q: What problem does the modified transsellar approach (mTSA) target in PitNET surgery?

PitNETs with anterosuperior extension are challenging for complete removal using the conventional transsellar approach due to limited access to the anterior suprasellar region.

Q: How was the surgical corridor expanded in the mTSA used in this study?

The mTSA added removal of the tuberculum sellae and planum sphenoidale while avoiding expansion of the dural incision.

Q: What were the main findings regarding tumor resection and complications?

Gross total resection was achieved in all patients. Complications were minimal, with cerebrospinal fluid leakage (3%), meningitis (3%), transient ocular movement disturbance (2%), and transient visual worsening (1%); no hemorrhage or anosmia occurred.

Sep 30, 2026

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Background/Objectives: Achieving gross total resection is crucial in surgical management of pituitary neuroendocrine tumors (PitNETs), yet tumors with anterosuperior extension are difficult to completely remove with the conventional transsellar approach (TSA). This study evaluated a modified TSA (mTSA) involving additional removal of the tuberculum sellae and planum sphenoidale without expanding the dural incision. Methods: Retrospective review of 104 nonfunctioning PitNET patients treated between 2017 and 2022. Results: Gross total resection occurred in all patients, mTSA enabled greater accessible tumor area and minimal complications. Conclusions: The corridor expansion supports complete resection with anterosuperior tumors.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages11

Reading Time28 min

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Abstract

Background/Objectives

Methods

Results

Conclusions

1. Introduction

Article Effectiveness of a Modified Transsellar Approach with Planum Sphenoidale Removal for Pituitary Neuroendocrine Tumors with Anterosuperior Extension Rei Yamaguchi , Masahiko Tosaka, Naoto Mukada , Masanori Aihara, Yuhei Yoshimoto and Soichi Oya * Received: 27 November 2025 Revised: 21 December 2025 Accepted: 31 December 2025 Published: 4 January 2026 Copyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan; [rei.yamaguchi@gunma-u.ac.jp](rei.yamaguchi@gunma-u.ac.jp) (R.Y.) * Correspondence: [sooya-gnm@gunma-u.ac.jp](sooya-gnm@gunma-u.ac.jp); Tel.: +81-27-220-8511; Fax: +81-27-220-8512 Abstract Background/Objectives: Achieving gross total resection is crucial in the surgical management of pituitary neuroendocrine tumors (PitNETs) . However, PitNETs with anterosuperior extension remain challenging to completely remove using the conventional transsellar approach (TSA) due to limited access to the anterior suprasellar region. This study evaluated the efficacy and safety of a modified TSA (mTSA) that involves additional removal of the tuberculum sellae and planum sphenoidale (PS) bones without expanding the dural incision. Methods: We retrospectively reviewed 104 patients with nonfunctioning PitNETs who underwent endoscopic transsphenoidal surgery between 2017 and 2022 . Seventy-seven patients were treated with the conventional TSA and 27 with the mTSA. Tumor configuration and accessible area were measured on pre-and postoperative MR imaging and CT. The ratio of the accessible to total tumor area was calculated on mid-sagittal images. Surgical outcomes and postoperative complications were compared between groups. Results: Gross total resection was achieved in all patients. Tumors treated with mTSA were larger (median height, 32 mm vs. 25 mm; p < 0.001) and showed greater anterosuperior extension. ThemTSA increased the median accessible tumor area from 70% to 88%, with a median PS removal distance of 4.4 mm. Postoperative complications were minimal: cerebrospinal fluid leakage (3%), meningitis (3%), transient ocular movement disturbance (2%), and transient visual worsening (1%) . No hemorrhage or anosmia occurred. Conclusions: ThemTSA safely expands the surgical corridor to the anterior suprasellar region, enhancing accessibility and enabling complete resection without dural incision. This approach balances surgical radicality and safety in PitNETs with anterosuperior extension. Keywords: endoscopic transsphenoidal surgery; pituitary neuroendocrine tumor; transsellar approach 1. Introduction Pituitary neuroendocrine tumors (PitNETs) are common, predominantly benign lesions that account for approximately 10–15% of primary intracranial tumors [1] . They arise in the sellar and/or suprasellar region and may enlarge to compress adjacent intracranial structures. Visual impairment is the most common presenting symptom, and patients may also develop ocular motor dysfunction and endocrine disturbances [2] . Although these tumors can attach to the optic apparatus, pituitary stalk, hypothalamus, and major cerebral arteries or their perforators, many PitNETs are extra-axial and can be resected safely [3] . Surgery remains a cornerstone of treatment for symptomatic PitNETs, particularly in patients with visual compromise and/or progressive mass effect. Over the last two decades, endoscopic transsphenoidal surgery (ETS) has been widely adopted for pituitary tumors owing to its panoramic visualization, improved illumination, and favorable working angles compared with microscopic techniques [4–7] . The primary goals of surgery are consistent across most PitNET subtypes: maximal safe tumor removal, durable decompression of the optic apparatus, a

FAQs

What problem does the modified transsellar approach (mTSA) target in PitNET surgery?

PitNETs with anterosuperior extension are challenging for complete removal using the conventional transsellar approach due to limited access to the anterior suprasellar region.

How was the surgical corridor expanded in the mTSA used in this study?

The mTSA added removal of the tuberculum sellae and planum sphenoidale while avoiding expansion of the dural incision.

What were the main findings regarding tumor resection and complications?

Gross total resection was achieved in all patients. Complications were minimal, with cerebrospinal fluid leakage (3%), meningitis (3%), transient ocular movement disturbance (2%), and transient visual worsening (1%); no hemorrhage or anosmia occurred.

Sep 30, 2026

Upload by jayni