Endoscopic approach for pituitary tumors

The goals of pituitary surgery are threefold: normalization of secretion of excess hormones, alleviation of compression related to mass effect and preservation of normal pituitary function. All of this must be accomplished while preserving sinonasal function and avoiding cerebrospinal fluid leak and damage to critical surrounding structures including the carotid arteries and optic nerves. The transsphenoidal route provides the safest and most effective route for surgical access to the sellar region for the overwhelming majority of pituitary tumors. While there are advantages and disadvantages to both the endoscopic and microscopic transsphenoidal approaches, the endoscopic technique provides wider field of view and improved line of sight, which may be particularly beneficial during resection of large macroadenomas. Overall, in experienced hands, the morbidity and mortality associated with the endoscopic endonasal transsphenoidal approach is low and the common complications (postoperative CSF rhinorrhea, endocrinopathy, vascular injury, and sinonasal complications) are usually mild and transient. Important predictors of outcome include size of the tumor, degree of extension and experience of the surgeon.