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Endoscopic Transsphenoidal Pituitary Surgery: Results and Complications

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Transsphenoidal Surgery

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Abstract

Endoscopic transsphenoidal pituitary surgery (ETPS) is rapidly replacing both the open transcranial as well as the transsphenoidal microscope-based techniques for resection of pituitary adenomas. This change has resulted from technological advances in lens and camera resolution, minimally invasive surgical instrumentation, and neuronavigation systems, leading to an improved field of view as well as more extensive approaches to skull-base lesions accessed through small portals. Angled endoscopes provide visualization of recesses inside the sella and direct visualization of the medial wall of the cavernous sinus, not accessible by the operating microscope. ETPS is also less invasive, with less postoperative pain, shorter hospitalization, and fewer postoperative complications than microscopic transsphenoidal surgery. The disadvantages include lack of depth perception, the need for an assistant or endoscope holder, and increased incidence of postoperative epistaxis. There is also a steep learning curve, requiring an average of 25–50 operations to learn the techniques necessary to operate using the endoscope. Despite this, experiences with ETPS have largely been positive, with benefits outweighing the costs. In this chapter, we look at the surgical outcomes of functional and nonfunctional pituitary adenomas, and further discuss complications associated with ETPS in general.

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  1. Harminder Singh and Walid I. Essayed have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA

    Harminder Singh MD

  2. Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA

    Walid I. Essayed MD

  3. Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA

    Ibrahim Hussain & Theodore H. Schwartz

  4. Baystate Health, Springfield, MA, USA

    Kryscilla Yang MD

  5. Department of Otolaryngology and Head and Neck Surgery, Weill Cornell Medical College, The New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA

    Vijay K. Anand MD, FACS

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  1. Harminder Singh MD
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  2. Walid I. Essayed MD
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  3. Ibrahim Hussain
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  6. Theodore H. Schwartz
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Correspondence to Theodore H. Schwartz .

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Editors and Affiliations

  1. Department of Neurosurgery, Harvard Medical School Brigham and Women’s Hospital, Boston, MA, USA

    Edward R. Laws, Jr

  2. Department of Neurosurgery, Indianapolis Methodist Hospital, Indianapolis, IN, USA

    Aaron A. Cohen-Gadol

  3. Department of Neurosurgery, Weill Cornell Medical College New York Presbyterian Hospital, New York, NY, USA

    Theodore H. Schwartz

  4. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA

    Jason P. Sheehan

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Singh, H., Essayed, W.I., Hussain, I., Yang, K., Anand, V.K., Schwartz, T.H. (2017). Endoscopic Transsphenoidal Pituitary Surgery: Results and Complications. In: Laws, Jr, E.R., Cohen-Gadol, A.A., Schwartz, T.H., Sheehan, J.P. (eds) Transsphenoidal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-56691-7_15

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