The application of craniofacial techniques and intracranial endoscopy to pituitary surgery

The evolution of pituitary surgery during the last century is characterized by the development of progressively less invasive approaches to the pituitary gland that have been facilitated by simultaneous advances in medical technology. Once performed via an open transcranial operation involving prolonged brain retraction, resection of pituitary tumors can now be performed via a direct transnasal approach entirely under endoscopic imaging. This review discusses the evolution of pituitary surgery from open transcranial techniques to the fully endoscopic transnasal procedure. However, in certain cases, with large pituitary tumors that have a significant extrasellar portion, a transcranial approach offers the greatest chance of complete tumor removal and often is reserved for the second stage of a two-staged operation. Recently, an endoscopic transglabellar minimally invasive approach has been reported, which could be used in place of the traditional transcranial approach.