Principles of Pituitary Surgery

• Published in: Otolaryngologic clinics of North America Vol. 49; no. 1; pp. 95 - 106
• Main Authors: Farrell, Christopher J., MD, Nyquist, Gurston G., MD, Farag, Alexander A., MD, Rosen, Marc R., MD, Evans, James J., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2016
• Subjects: Endoscopy - methods; Endoscopy versus microscopy; Humans; Magnetic Resonance Imaging; Nose - surgery; Otolaryngology; Otorhinolaryngologic Surgical Procedures - methods; Pituitary Gland - surgery; Pituitary Neoplasms - surgery; Pituitary surgery; Pituitary tumors; Surgery; Tomography, X-Ray Computed; Transnasal; Transsphenoidal; Transsphenoidal; Transnasal; Pituitary surgery; Pituitary tumors; Endoscopy versus microscopy
• ISSN: 0030-6665; 1557-8259
• DOI: 10.1016/j.otc.2015.09.005

Since the description of a transnasal approach for treatment of pituitary tumors, transsphenoidal surgery has undergone continuous development. Hirsch developed a lateral endonasal approach before simplifying it to a transseptal approach. Cushing approached pituitary tumors using a transsphenoidal approach but transitioned to the transcranial route. Transsphenoidal surgery was not “rediscovered” until Hardy introduced the surgical microscope. An endoscopic transsphenoidal approach for pituitary tumors has been reported and further advanced. We describe the principles of pituitary surgery including the key elements of surgical decision making and discuss the technical nuances distinguishing the endoscopic from the microscopic approach.