Skull Base 2007; 17(6): 369-378
DOI: 10.1055/s-2007-986426
ORIGINAL ARTICLE

© Thieme Medical Publishers

The Role of the Le Fort I Maxillotomy in the Management of Incompletely Resected Pituitary Macroadenomas

Bruce Mickey1 , Leslie Hutchins1 , Edward Ellis2  III 
  • 1Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas
  • 2Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
Further Information

Publication History

Publication Date:
20 August 2007 (online)

ABSTRACT

Objective: The options available for the treatment of a nonsecreting pituitary macroadenoma that has been incompletely resected include reoperation, fractionated radiation therapy, and radiosurgery. Reoperation in this setting may be hindered by the same obstacles that prevented a complete resection during the initial surgical procedure, and should prompt consideration of an alternate approach or exposure. Methods: Between January 1998 and December 2003, 10 consecutive patients were referred to the Department of Neurosurgery at the University of Texas Southwestern Medical Center for the evaluation of a nonsecreting pituitary macroadenoma that measured 3 cm or greater in diameter despite having undergone an attempt at a complete resection elsewhere. Each of these patients was reoperated using a Le Fort I maxillotomy to enhance the exposure provided by a traditional transsphenoidal approach. Results: A total or near total (> 95%) resection was achieved in each case. One patient required reoperation for the repositioning of a fat graft to treat a cerebrospinal fluid fistula and one patient experienced a worsening of anterior pituitary function postoperatively. Five patients noted improved vision and no patient experienced further visual loss. Three patients have required subsequent treatment of small foci of recurrent or progressing tumor with stereotactic radiation therapy. No patient has received fractionated radiation therapy. Conclusion: The added exposure provided by a Le Fort I maxillotomy facilitates the resection of pituitary macroadenomas that have been incompletely resected by a traditional transnasal, trans-sphenoidal approach.

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Bruce MickeyM.D. 

Department of Neurosurgery, University of Texas Southwestern Medical Center

5323 Harry Hines Boulevard, Dallas, TX 75390-8855

Email: Bruce.Mickey@UTSouthwestern.edu