Surgical techniques in transsphenoidal surgery: what is the standard of care in pituitary adenoma surgery?

Abstract

Purpose of review The transsphenoidal approach represents the standard of care for the overwhelming majority of pituitary adenomas. Recently several surgical adjuncts and variations on the transsphenoidal technique have been described. Recent findings The versatility of the transsphenoidal corridor is exemplified by the variety of approaches available. Microscopic adenomectomies are currently performed by use of the traditional sublabial transseptal approach, the endonasal transseptal approach, or several direct transnasal approaches. The introduction of pure endonasal endoscopic transsphenoidal adenomectomy represents a new phase in the evolution of the transsphenoidal approach. The surgical approach can be facilitated by frameless stereotaxy, and the extent of tumor resection can be assessed by several modalities, including endoscopy, ultrasonography, and intraoperative MRI. Each of these technical adjuncts has unique advantages and drawbacks. Summary Amid the variety of transsphenoidal approaches and technical adjuncts, it is only the corridor itself that currently can be called the standard of care. Each approach and adjunct has its place in specific clinical situations. The versatile surgeon who has access to and is comfortable with each will be able to provide the ideal care for each patient.