{"id":4422301,"date":"2025-01-11T13:00:44","date_gmt":"2025-01-11T19:00:44","guid":{"rendered":"https:\/\/myendoconsult.com\/learn\/topics\/types-of-pituitary-surgery\/"},"modified":"2025-01-13T06:48:06","modified_gmt":"2025-01-13T12:48:06","slug":"types-of-pituitary-surgery","status":"publish","type":"oen_topic","link":"https:\/\/myendoconsult.com\/learn\/topics\/types-of-pituitary-surgery\/","title":{"rendered":"Types of Pituitary Surgery"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">SURGICAL APPROACHES TO THE PITUITARY<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Surgical Goals<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Complete Resection of the Pituitary Adenoma<\/strong>\n<ul class=\"wp-block-list\">\n<li>Corrects visual field defects<\/li>\n\n\n\n<li>Cures hormone excess syndrome (e.g., acromegaly, <a href=\"https:\/\/myendoconsult.com\/learn\/topics\/cushings-disease\/\" data-wpil-monitor-id=\"81\">Cushing disease<\/a>)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Avoid Complications<\/strong>\n<ul class=\"wp-block-list\">\n<li>Prevent cerebrospinal fluid (CSF) rhinorrhea<\/li>\n\n\n\n<li>Prevent neurologic damage<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Preserve Viable Pituitary Tissue<\/strong>\n<ul class=\"wp-block-list\">\n<li>Avoid postoperative hypopituitarism<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<h3 class=\"wp-block-heading\">Determinants of Surgical Success<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Tumor Size, Location, and Consistency<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Microadenomas (\u226410 mm)<\/strong>: ~80%\u201390% cure rate<\/li>\n\n\n\n<li><strong>Macroadenomas (&gt;10 mm)<\/strong>: ~50%\u201360% cure rate<\/li>\n\n\n\n<li><strong>&gt;20 mm tumors<\/strong>: ~20% cure rate<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Cavernous Sinus Invasion<\/strong>\n<ul class=\"wp-block-list\">\n<li>Typically prevents complete tumor removal.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Suprasellar Extension<\/strong>\n<ul class=\"wp-block-list\">\n<li>Adhesion to the optic chiasm\/hypothalamus may limit resection and risk vision loss or hypothalamic damage.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Tumor Consistency<\/strong>\n<ul class=\"wp-block-list\">\n<li>Soft adenomas are more easily curetted; fibrous adenomas are more challenging.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">HISTORICAL PERSPECTIVE OF PITUITARY SURGERY<\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Early 1900s<\/strong>\n<ul class=\"wp-block-list\">\n<li>Sublabial transseptal transsphenoidal approach introduced.<\/li>\n\n\n\n<li>Abandoned due to high infection-related mortality.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>1930s\u20131960s<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Transfrontal Craniotomy<\/strong> was the main surgical route to the pituitary.<\/li>\n\n\n\n<li>Associated with higher morbidity and mortality.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Late 1960s\u20131990s<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Sublabial Transseptal Transsphenoidal Approach<\/strong> reintroduced.<\/li>\n\n\n\n<li>Use of operative microscopes and antibiotics reduced infection risk.<\/li>\n\n\n\n<li>Involved a sublabial incision and removal of the nasal septum to access the sphenoid sinus and sella turcica.<\/li>\n\n\n\n<li>Common complications included nasal septal perforation, front teeth\/upper lip numbness, and the need for nasal packing.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>1990s\u2013Present<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Direct Transnasal Transsphenoidal Approach<\/strong> (microscopic or endoscopic).<\/li>\n\n\n\n<li>No external incision needed, avoids large septal disruption.<\/li>\n\n\n\n<li>Shorter operative\/anesthesia time, shorter hospital stay (~1 night).<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">DIRECT TRANSNASAL TRANSSPHENOIDAL APPROACH<\/h2>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"3150\" height=\"2100\" src=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/TSS-approach.png\" alt=\"\" class=\"wp-image-4422842\" srcset=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/TSS-approach.png 3150w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/TSS-approach-300x200.png 300w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/TSS-approach-768x512.png 768w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/TSS-approach-1536x1024.png 1536w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/TSS-approach-2048x1365.png 2048w\" sizes=\"auto, (max-width: 3150px) 100vw, 3150px\" \/><figcaption class=\"wp-element-caption\">Transnasal Transsphenoidal Approach<\/figcaption><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Microscopic Technique<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Procedure<\/strong>\n<ol class=\"wp-block-list\">\n<li>A narrow speculum is placed into the nostril to reach the sphenoid ostia.<\/li>\n\n\n\n<li>A small mucosal incision is made at the posterior nasal passage (no major disruption to the septum).<\/li>\n\n\n\n<li>The sphenoid sinus is opened under microscopic vision to expose the sella turcica.<\/li>\n\n\n\n<li>The tumor is removed under direct microscopic view.<\/li>\n<\/ol>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Endoscopic Technique<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Procedure<\/strong>\n<ol class=\"wp-block-list\">\n<li>A nasal endoscope is advanced through a nostril.<\/li>\n\n\n\n<li>The sphenoid ostium is enlarged, and the posterior vomer portion is removed, allowing access to the sphenoid sinus.<\/li>\n\n\n\n<li>A self-retaining nasal speculum is placed, and the sella is opened.<\/li>\n\n\n\n<li>The adenoma is resected under endoscopic visualization.<\/li>\n\n\n\n<li>The nasal speculum is withdrawn; the septum is adjusted, and a \u201cmustache\u201d dressing is applied.<\/li>\n<\/ol>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Advantages<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>No external incision<\/li>\n\n\n\n<li>Reduced nasal septal damage<\/li>\n\n\n\n<li>Faster operative time<\/li>\n\n\n\n<li>Lower postoperative discomfort and shorter hospital stay<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">POTENTIAL COMPLICATIONS<\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Intraoperative<\/strong>\n<ul class=\"wp-block-list\">\n<li>Injury to the cavernous carotid artery<\/li>\n\n\n\n<li>Injury to optic pathways<\/li>\n\n\n\n<li>Injury to <a href=\"https:\/\/myendoconsult.com\/learn\/mnemonic-cranial-nerves-dirty-surprise\/\" data-wpil-monitor-id=\"82\">cranial nerves<\/a> III, IV, V, and VI<\/li>\n\n\n\n<li>CSF leakage<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Postoperative<\/strong>\n<ul class=\"wp-block-list\">\n<li>Sellar hematoma<\/li>\n\n\n\n<li>CSF rhinorrhea<\/li>\n\n\n\n<li>Meningitis<\/li>\n\n\n\n<li>Hypopituitarism<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">ROLE OF THE TRANSCRANIAL APPROACH<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Indications<\/strong>\n<ul class=\"wp-block-list\">\n<li>~90% of sellar\/parasellar tumors can be resected via the transnasal route.<\/li>\n\n\n\n<li><strong>Transcranial approach<\/strong> is reserved for lesions:\n<ul class=\"wp-block-list\">\n<li>Extending into the middle fossa<\/li>\n\n\n\n<li>Having large, complex suprasellar involvement<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>SURGICAL APPROACHES TO THE PITUITARY Surgical Goals Determinants of Surgical Success HISTORICAL PERSPECTIVE OF PITUITARY SURGERY DIRECT TRANSNASAL TRANSSPHENOIDAL APPROACH Microscopic Technique Endoscopic Technique&hellip;<\/p>\n","protected":false},"featured_media":0,"template":"","oen_topic_chapter":[682],"class_list":["post-4422301","oen_topic","type-oen_topic","status-publish","hentry","oen_topic_chapter-pituitary-gland"],"_links":{"self":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422301","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic"}],"about":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/types\/oen_topic"}],"version-history":[{"count":5,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422301\/revisions"}],"predecessor-version":[{"id":4422844,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422301\/revisions\/4422844"}],"wp:attachment":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/media?parent=4422301"}],"wp:term":[{"taxonomy":"oen_topic_chapter","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic_chapter?post=4422301"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}