Skip to main content

Abstract

Pituitary surgery is a distinct subspecialty of neurosurgery in which specific knowledge and interest of pituitary pathophysiology go with precise awareness of basic neurosurgical techniques and associated skills. Nowadays the neurosurgeon has more than one option, including the medical, surgical, and radiotherapeutic ones, alone or in various combinations, in order to manage many of the different pituitary syndromes. The best outcomes for pituitary surgery are obtained in centers where the entire range of pituitary specialties is offered in an environment of effective teamwork. The postoperative management with a long-term patient follow-up in pituitary surgery, perhaps more than other areas of neurosurgery, makes the difference between a satisfactory result and a poor result. It is in such a context that pituitary surgery should be approached today, where the neurosurgeon dealing with techniques, indications, and results resembles a member of an orchestra who is playing a refined instrument. The neurosurgeon must have a keen perception, good instincts, steady hands, and the ability to perform a tailor-made operation for the individual patient and not mass.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 149.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Bibliography

  1. Naidich MJ, Russell EJ (1999) Current approaches to imaging of the sellar region and pituitary. Endocrinol Metab Clin North Am 28:45–79, vi

    Article  CAS  PubMed  Google Scholar 

  2. Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD, Brue T, Cappabianca P, Colao A, Fahlbusch R, Fideleff H, Hadani M, Kelly P, Kleinberg D, Laws E, Marek J, Scanlon M, Sobrinho LG, Wass JA, Giustina A (2006) Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin Endocrinol (Oxf) 65:265–273

    Article  Google Scholar 

  3. Giustina A, Casanueva FF, Cavagnini F, Chanson P, Clemmons D, Frohman LA, Gaillard R, Ho K, Jaquet P, Kleinberg DL, Lamberts SW, Lombardi G, Sheppard M, Strasburger CJ, Vance ML, Wass JA, Melmed S (2003) Diagnosis and treatment of acromegaly complications. J Endocrinol Invest 26:1242–1247

    Article  CAS  PubMed  Google Scholar 

  4. Giustina A, Melmed S (2003) Acromegaly consensus: the next steps. J Clin Endocrinol Metab 88:1913–1914

    Article  PubMed  Google Scholar 

  5. Melmed S, Vance ML, Barkan AL, Bengtsson BA, Kleinberg D, Klibanski A, Trainer PJ (2002) Current status and future opportunities for controlling acromegaly. Pituitary 5:185–196

    Article  CAS  PubMed  Google Scholar 

  6. Scacchi M, Cavagnini F (2006) Acromegaly. Pituitary 9:297–303

    Article  PubMed  Google Scholar 

  7. Trainer PJ (2002) Editorial: acromegaly – consensus, what consensus? J Clin Endocrinol Metab 87:3534–3536

    CAS  PubMed  Google Scholar 

  8. De Martin M, Giraldi FP, Cavagnini F (2006) Cushing’s disease. Pituitary 9:279–287

    Article  PubMed  Google Scholar 

  9. Jaffe CA (2006) Clinically non-functioning pituitary adenoma. Pituitary 9:317–321

    Article  PubMed  Google Scholar 

  10. Katznelson L, Klibanski A (1996) Endocrine-inactive, FSH, LH and a-subunit adenomas: clinical findings and endocrinology. In: Landolt AM, Vance ML, Reilly PL (eds) Pituitary adenomas. Churchill Livingstone, New York, pp 127–138

    Google Scholar 

  11. Buurman H, Saeger W (2006) Subclinical adenomas in postmortem pituitaries: classification and correlations to clinical data. Eur J Endocrinol 154:753–758

    Article  CAS  PubMed  Google Scholar 

  12. Harris PE (1998) Biochemical markers for clinically non-functioning pituitary tumours. Clin Endocrinol (Oxf) 49:163–164

    Article  CAS  Google Scholar 

  13. Chong VF, Fan YF, Lau D, Sethi DS (1998) Functional endoscopic sinus surgery (FESS): what radiologists need to know. Clin Radiol 53:650–658

    Article  CAS  PubMed  Google Scholar 

  14. Mason JD, Jones NS, Hughes RJ, Holland IM (1998) A systematic approach to the interpretation of computed tomography scans prior to endoscopic sinus surgery. J Laryngol Otol 112:986–990

    CAS  PubMed  Google Scholar 

  15. Hardy J, Somma M (1979) Acromegaly. Surgical treatment by transsphenoidal microsurgical removal of the pituitary adenoma. In: Collins WF, Tindall GT (eds) Clinical management of pituitary disorders. Raven Press, New York, pp 209–217

    Google Scholar 

  16. Bills D, Meyer F, Laws ER Jr et al (1993) A retrospective analysis of pituitary apoplexy. Neurosurgery 33:602–609

    Article  CAS  PubMed  Google Scholar 

  17. Ebersold MJ, Laws ER Jr, Scheithauer BW et al (1983) Pituitary apoplexy treated by transsphenoidal surgery: a clinicopathological and immunocytochemical study. J Neurosurg 58:315–320

    Article  CAS  PubMed  Google Scholar 

  18. Laws ER Jr, Trautmann JC, Hollenhorst RW Jr (1977) Transsphenoidal decompression of the optic nerve and chiasm: visual results in 62 patients. J Neurosurg 46:717–722

    Article  PubMed  Google Scholar 

  19. Laws ER Jr (1997) Surgical management of pituitary apoplexy. In: Welch K, Caplan L, Reis D (eds) Primer on cerebrovascular diseases. Academic, New York, pp 508–510

    Chapter  Google Scholar 

  20. Bevan JS, Webster J, Burke CW, Scanlon MF (1992) Dopamine agonists and pituitary tumor shrinkage. Endocr Rev 13:220–240

    Article  CAS  PubMed  Google Scholar 

  21. Lohmann T, Trantakis C, Biesold M, Prothmann S, Guenzel S, Schober R, Paschke R (2001) Minor tumour shrinkage in nonfunctioning pituitary adenomas by long-term treatment with the dopamine agonist cabergoline. Pituitary 4:173–178

    Article  CAS  PubMed  Google Scholar 

  22. Shomali ME, Katznelson L (1999) Medical therapy for gonadotroph and thyrotroph tumors. Endocrinol Metab Clin North Am 28:223–240, viii

    Article  CAS  PubMed  Google Scholar 

  23. Colao A, Di Sarno A, Cappabianca P, Di Somma C, Pivonello R, Lombardi G (2003) Withdrawal of long-term cabergoline therapy for tumoral and nontumoral hyperprolactinemia. N Engl J Med 349:2023–2033

    Article  CAS  PubMed  Google Scholar 

  24. Molitch ME, Elton RL, Blackwell RE, Caldwell B, Chang RJ, Jaffe R, Joplin G, Robbins RJ, Tyson J, Thorner MO (1985) Bromocriptine as primary therapy for prolactin-secreting macroadenomas: results of a prospective multicenter study. J Clin Endocrinol Metab 60:698–705

    Article  CAS  PubMed  Google Scholar 

  25. Molitch ME (2003) Dopamine resistance of prolactinomas. Pituitary 6:19–27

    Article  CAS  PubMed  Google Scholar 

  26. Semple PL, Webb MK, de Villiers JC, Laws ER Jr (2005) Pituitary apoplexy. Neurosurgery 56:65–72, discussion 72–63

    PubMed  Google Scholar 

  27. Giusti M, Ciccarelli E, Dallabonzana D, Delitala G, Faglia G, Liuzzi A, Gussoni G, Giordano Disem G (1997) Clinical results of long-term slow-release lanreotide treatment of acromegaly. Eur J Clin Invest 27:277–284

    Article  CAS  PubMed  Google Scholar 

  28. Giustina A, Barkan A, Casanueva FF, Cavagnini F, Frohman L, Ho K, Veldhuis J, Wass J, Von Werder K, Melmed S (2000) Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab 85:526–529

    CAS  PubMed  Google Scholar 

  29. Jaffe CA, Barkan AL (1992) Treatment of acromegaly with dopamine agonists. Endocrinol Metab Clin North Am 21:713–735

    CAS  PubMed  Google Scholar 

  30. Schmitt H, Buchfelder M, Radespiel-Troger M, Fahlbusch R (2000) Difficult intubation in acromegalic patients: incidence and predictability. Anesthesiology 93:110–114

    Article  CAS  PubMed  Google Scholar 

  31. Fahlbusch R, Buchfelder M, Nomikos P (2002) Pituitary surgery. In: Melmed S (ed) The pituitary. Blackwell, Malden, pp 405–417

    Google Scholar 

  32. Horsley V (1906) Address in surgery on the technic of operation on the central nervous system. Br Med J 2:411–423

    Article  PubMed Central  Google Scholar 

  33. Caton R, Paul FT (1893) Notes on a case of acromegaly treated by operation. Br Med J 2:1421–1423

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  34. Jane JA Jr, Thapar K, Laws ER Jr (2002) A history of pituitary surgery. Oper Techn Neurosurg 5:200–209

    Article  Google Scholar 

  35. Schloffer H (1907) Erfolgreiche Operationen eines Hypophysentumors auf Nasalem Wege. Wien Clin Wochenschr 20:621–624

    Google Scholar 

  36. Artico M, Pastore FS, Fraioli B et al (1998) The contribution of Davide Giordano (1864–1954) to pituitary surgery: the transglabellar-nasal approach. Neurosurgery 42:909–912

    Article  CAS  PubMed  Google Scholar 

  37. Giordano D (1911) Compendio di Chirurgia Operativa Italiana. UTET, Torino, pp 100–103

    Google Scholar 

  38. von Eiselsberg A, von Frankl-Hochwart L (1907) Uber die operative Behandlung der Tumoren der Hypophysisge- gend. Neurol Centralblatt 26:994–1001

    Google Scholar 

  39. Kocher T (1909) Ein Fall von Hypophysis-Tumor mit Operativer Heilung. Dtsch Zeitschrift Chir 100:13–37

    Article  Google Scholar 

  40. Lanzino G, Laws ER Jr (2001) Pioneers in the development of transsphenoidal surgery: Theodor Kocher, Oskar Hirsch, and Norman Dott. J Neurosurg 95:1097–1103

    Article  CAS  PubMed  Google Scholar 

  41. Kanavel AB (1909) The removal of tumors of the pituitary body by an infranasal route: a proposed operation with a description of the technique. JAMA 53:1704–1707

    Article  Google Scholar 

  42. Kanavel AB, Grinker J (1910) Removal of tumors of the pituitary body with a suggestion as to a two-step route, and a report of a case with a malignant tumor operated upon with primary recovery. Surg Gynecol Obstet 10:414–418

    Google Scholar 

  43. Hirsch O (1911) Uber Methoden der Behandlung von Hypophysistumoren auf endonasalem Wege. Arch Laryngol Rhinol 24:129–177

    Google Scholar 

  44. Hajek M (1904) Zur Diagnose und intranasalen chirurgischen Behandlung der Eiterungen der Keilbeinhöhle und des hinteren Siebbeinlabyrinthes. Arch Laryngol Rhinol 16:105–143

    Google Scholar 

  45. Kilian G (1904) Die submuköse Fensterresektion der Nasen- scheidewand. Arch Laryngol Rhinol 16:362–387

    Google Scholar 

  46. Hamlin H (1981) Oskar Hirsch. Surg Neurol 16:391–393

    Article  CAS  PubMed  Google Scholar 

  47. Halstead AE (1910) The operative treatment of tumors of the hypophysis. Surg Gynecol Obstet 10:494

    Google Scholar 

  48. Halstead AE (1910) Remarks on the operative treatment of tumors of the hypophysis: with the report of two cases operated on by an oronasal method. Trans Am Surg Assoc 28:73–93

    Google Scholar 

  49. Cushing H (1909) Partial hypophysectomy for acromegaly: with remarks on the functions on the hypophysis. Ann Surg 30:1002–1017

    Article  Google Scholar 

  50. Cushing H (1914) Surgical experiences with pituitary disorders. JAMA 63:1515–1525

    Article  Google Scholar 

  51. Cushing H (1932) Intracranial tumors: notes upon a series of two thousand verified cases with surgical-mortality percentages pertaining thereto. Charles C Thomas, Springfield, pp 69–79

    Google Scholar 

  52. Rosegay H (1981) Cushing’s legacy to transsphenoidal surgery. J Neurosurg 54:448–454

    Article  CAS  PubMed  Google Scholar 

  53. Dandy WE (1934) The brain. In: Lewis D (ed) Practice of surgery. WF Prior, Hagerstown, pp 556–605

    Google Scholar 

  54. Heuer GJ (1920) Surgical experiences with an intracranial approach to chiasmal lesions. Arch Surg 1:368–381

    Article  Google Scholar 

  55. Heuer GJ (1931) The surgical approach and the treatment of tumors and other lesions about the optic chiasm. Surg Gynecol Obstet 53:489–518

    Google Scholar 

  56. Liu JK, Das K, Weiss MH et al (2001) The history and evolution of transsphenoidal surgery. J Neurosurg 95:1083–1096

    Article  CAS  PubMed  Google Scholar 

  57. Hardy J (1969) Transsphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg 16:185–217

    CAS  PubMed  Google Scholar 

  58. Cappabianca P, de Divitiis O, Maiuri F (2003) Evolution of transsphenoidal surgery. In: de Divitiis E, Cappabianca P (eds) Endoscopic endonasal transsphenoidal surgery. Springer, New York, pp 1–7

    Chapter  Google Scholar 

  59. Guiot G, Rougerie J, Fourestier M et al (1963) Explorations endoscopiques intracraniennes. Presse Med 71:1225–1228

    CAS  PubMed  Google Scholar 

  60. Carrau R, Jho HD, Ko Y (1996) Transnasal-transsphenoidal endoscopic surgery of the pituitary gland. Laryngoscope 106:914–918

    Article  CAS  PubMed  Google Scholar 

  61. Jho HD, Carrau RL, Ko Y (1996) Endoscopic pituitary surgery. In: Wilkins H, Rengachary S (eds) Neurosurgical operative atlas. American Association of Neurological Surgeons, Park Ridge, pp 1–12

    Google Scholar 

  62. Cappabianca P, Alfieri A, de Divitiis E (1998) Endoscopic endonasal transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS). Minim Invasive Neurosurg 41:66–73

    Article  CAS  PubMed  Google Scholar 

  63. de Divitiis E, Cappabianca P, Cavallo LM (2003) Endoscopic endonasal transsphenoidal approach to the sellar region. In: de Divitiis E, Cappabianca P (eds) Endoscopic endonasal T transsphenoidal surgery. Springer, New York, pp 91–130

    Chapter  Google Scholar 

  64. Di Maio S, Cavallo LM, Esposito F, Stagno V, Corriero OV, Cappabianca P (2011) Extended endoscopic endonasal approach for selected pituitary adenomas: early experience. J Neurosurg 114(2):345–353. doi:10.3171/2010.9.JNS10262, Epub 2010 Nov 5

    Article  PubMed  Google Scholar 

  65. Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH (2012) Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of giant pituitary adenomas. Pituitary 15(2):150–159

    Article  PubMed  Google Scholar 

  66. Juraschka K, Khan OH, Godoy BL, Monsalves E, Kilian A, Krischek B, Ghare A, Vescan A, Gentili F, Zadeh G (2014) Endoscopic endonasal transsphenoidal approach to large and giant pituitary adenomas: institutional experience and predictors of extent of resection. J Neurosurg 2

    Google Scholar 

  67. Frank G, Pasquini E (2006) Endoscopic endonasal cavernous sinus surgery, with special reference to pituitary adenomas. Front Horm Res 34:64–82

    Article  PubMed  Google Scholar 

  68. Woodworth GF, Patel KS, Shin B, Burkhardt JK, Tsiouris AJ, McCoul ED, Anand VK, Schwartz TH (2014) Surgical outcomes using a medial-to-lateral endonasal endoscopic approach to pituitary adenomas invading the cavernous sinus. J Neurosurg 120(5):1086–1094

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Paolo Cappabianca MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Cappabianca, P., Del Basso De Caro, M., Villa, A. (2016). Introduction. In: Cappabianca, P., Cavallo, L., de Divitiis, O., Esposito, F. (eds) Midline Skull Base Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-21533-4_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-21533-4_1

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-21532-7

  • Online ISBN: 978-3-319-21533-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics