Transsphenoidal surgery

Abstract

Transsphenoidal surgery has evolved much over nearly 100 years. Initially operations were performed often without any input from endocrinology colleagues, and without preoperative imaging, operative magnification and illumination. Advances in the understanding of the biology of pituitary tumours, close co-operation between endocrinologists, surgeons and oncologists, and huge advances in imaging and surgical techniques have led to the evolution of the current transsphenoidal operation to the pituitary fossa to the point where a 'cure' is often possible with low complication rates. The indications, contraindications of transsphenoidal surgery will be discussed, together with nature of the surgical approach and how it can be applied to particular pituitary tumours and suprasellar lesions.

Biochemical Predictors of Outcome of Pituitary Surgery for Cushing’s Disease

“…Transsphenoidal surgery (TS) is the first choice of treatment for CD. Although being a safe treatment, with a reported 30-day mortality in experienced hands of less than 1%, surgical cure is not achieved in all patients [1,2,3]. The reported initial success rate for pituitary surgery for CD varies between 60 and 86%, however the true rate tends to be lower since up to 25% of patients suffer from recurrence after apparent remission [4,5,6,7,8,9,10,11,12].…”

Bifocal intracranial tumors of nongerminomatous germ cell etiology: diagnostic and therapeutic implications

“…Such an approach offers low morbidity and mortality, although CSF leakage, endocrine abnormalities involving the anterior pituitary, and diabetes insipidus may occur. 30 In summary, given that sampling of tissue from both the pineal and neurohypophyseal regions can be accomplished via minimally invasive routes with mild adverse effects and very low rates of mortality, the benefits of biopsy in patients with bifocal tumors may outweigh the risks associated with the procedure.…”

Craniocaudal Extension as an Indication of Surgical Outcome in Transsphenoidal Surgery for Pituitary Adenomas

“…The transsphenoidal approach has evolved into the firstline method of treatment for sellar lesions that offer a minimally invasive approach [12][13][14]. Recent sophisticated techniques with improvements in radiographic imaging, and biochemical detection of hormonal abnormalities have raised the number of surgical procedures [3,9].…”

“…Recent sophisticated techniques with improvements in radiographic imaging, and biochemical detection of hormonal abnormalities have raised the number of surgical procedures [3,9]. Advances in the operative microsurgical techniques, magnification and illumination contributed to the resurgence of this approach [12][13][14].…”

“…Transsphenoidal surgery can be done as an initial treatment followed by a transcranial approach [13,17]. A second staged transsphenoidal approach can be contemplated if there is descent of the remaining tumor in the sella [18,19].…”