The Direct Endoscopic Endonasal Transsphenoidal Approach to the Pituitary Gland

Abstract

Over the past two decades, the endoscopic endonasal transsphenoidal approach to the pituitary gland and sellar region for the treatment of pituitary pathology has evolved rapidly. The direct endoscopic endonasal transsphenoidal approach consists of a nasal stage, a sphenoid stage, a sellar stage, and a reconstruction stage. Integration of the endoscope into pituitary surgery affords the surgeon superior panoramic visualization and illumination compared with the traditional microscopic approach. Additionally, the endoscopic approach facilitates two-handed surgical microdissection and the ability to look around anatomic surgical corners using angled lenses, which in turn may promote maximal tumor resection and preservation of the normal pituitary gland. This chapter focuses on key anatomic landmarks and operative strategies pertaining to the direct endoscopic endonasal approach to the sella. Continued experience and familiarity with the endoscopic transsphenoidal approach, combined with technologic advancements and improved instrumentation, are likely to contribute to improved surgical outcomes in the future.