Endoscopic Transnasal Transsphenoidal Pituitary Surgery

The minimally invasive, endoscopic approach to resection of pituitary adenomas has advanced the field of pituitary surgery dramatically.  The development of improved endoscopes and the gaining popularity and familiarity of endoscopic sinus surgery by otolaryngologists has led naturally to the extension of this approach to the pituitary region and skull base.  Standard approaches to this region require either an incision in the upper gum or placement of a large speculum in the nose to facilitate use of the operative microscope within the surgical field.  A transnasal approach makes use of the natural passage from the nostrils to the floor of the sphenoid sinus and, ultimately, the pituitary sella.  No separate incision is required.  Performing the surgery without speculum placement also leads to a better cosmetic result and less post-operative pain.  Patients rarely need nasal packing following this approach, in contrast to traditional exposures.  Operative times are shorter, and most patients are discharged within 24-48 hours.

In addition to the cosmetic benefits and shorter hospitalizations, the use of the endoscope improves visualization during surgery.  Newer endoscopes have better light sources and are more easily manipulated during surgery to provide a greater overall understanding of the surgical anatomy.  Many allow for the placement of angled scopes which are capable of "seeing around corners" within the sella to assist with a more complete removal of adenomatous tissue unseen with the operative microscope.  Several case series have also reported a decrease in operative complications including CSF leak, meningitis, diabetes insipidus, pituitary insufficiency, as well as a decrease in tumor recurrence or retention of residual tumor.

The endoscopic approach to the pituitary region offers many benefits over traditional approaches.  Improved visualization within the surgical field allows for greater confidence in a complete resection of the abnormal tissue with preservation of the normal gland, fewer post-operative complications, and improved patient outcomes.  The use of a natural passage to the sella precludes the need for a separate incision, improved cosmesis, shorter hospital stays, and greater patient satisfaction.