Endoscopic transnasal transsphenoidal pituitary surgery

Abstract

With the development of minimally invasive endoscopic nasal and sinus surgical techniques, endoscopic approaches to the pituitary gland have become more popular. Because of concerns about midline exposure of the sella, initially reported procedures included a sublabial or transseptal approach to the sphenoid sinus, occasionally with the use of endoscopes. Variations on these techniques, mostly endoscopic transnasal approaches to the sphenoid sinus, give near-midline exposure of the sella and allow far less disruption of normal structures. The differences described in the procedure may be in the type of scope used (microscope, endoscope, or both), or in minor technical variations. These approaches allow minimal disruption of anterior structures and hasten postoperative healing. These techniques are reported to be very safe and allow excellent exposure with superb magnification. The technique used by the author will be described in detail here. Angled scopes with an irrigation apparatus provide a view of suprasellar tumor extent. In addition, intraoperative CT or MRI guidance may be used to perform these procedures. Hospital stays have been significantly shortened, minimal to no packing is placed, and patient comfort is enhanced.