Use of endoscopic techniques for pituitary adenoma resection

The progressive refinement of transsphenoidal pituitary surgery has continued under a minimally invasive endoscopic strategy. The physical advantages of the endoscope allow a transsphenoidal approach through a natural nasal air pathway without the need for a transsphenoidal retractor. The unique optical characteristics of an endoscope provide great advantages in pituitary tumor surgery, particularly for macroadenomas. Wide-angled panoramic views at the posterior wall of the sphenoidal sinus allow clear anatomic orientation in comparison to the limited sellar exposure in conventional microscopic techniques. Angled-lens views allow direct visualization at the suprasellar region or various anatomic corners. Close-up internal views at the tumor resection cavity render minute details at the tumor removal site, allowing further cleansing of any residual crumbs of tumor tissue. There is greater postoperative comfort, more rapid recovery, and shorter hospital stay with endoscopic endonasal surgery than in techniques involving conventional septal dissection through a sublabial or transfixational incision with postoperative nasal packing and intensive-care unit stay. In addition, endoscopic techniques can have particular advantages for the surgical removal of many other types of tumors that could extend to the suprasellar region, invade into the cavernous sinus, project toward the anterior cranial fossa, or extend to the clivus. Although an endoscope can initially be used as an adjunctive tool for the placement of an endonasal transsphenoidal retractor or visualization of anatomic corners during microscopic pituitary surgery, it should widely replace the operating microscope when pituitary surgeons become effectively trained in endoscopic tumor resection and proper instruments are commercially available. Recent advances in endoscopic pituitary adenoma resection are discussed.