Endoscopic Pituitary Surgery: A Minimally Invasive Technique

Abstract

The sublabial transseptal transsphenoidal approach using the operating microscope to provide illumination and magnification is the standard approach for the majority of pituitary adenomas in most institutions. This approach combines a sublabial incision with a transfixion incision, and often requires removal of the anterior nasal spine and dislocation or removal of the quadrilateral septal cartilage. We describe an endoscopic technique that is minimally invasive, requiring only a hemitransfixion incision, and preserving the anterior nasal spine. Often, it is not necessary to dislocate the septal cartilage from the maxillary crest. The surgery is performed using a 4 mm 0 degree telescope. Angled 30 degree and 70 degree telescopes are used to visualize the intrasphenoid anatomy, and may be introduced in the sellar cavity following tumor removal, to ensure complete extirpation. This minimally invasive technique has been successfully used in 80 patients with sellar lesions. The use of endoscopes offered not only the advantage of improved visualization, but also magnification and a panoramic perspective of the important anatomical relationships of the sella turcica. It also enabled more complete tumor removal with minimally invasive techniques.