Transsphenoidal hypophysectomy: a critical review

The approach to resection of pituitary tumors has undergone radical changes over the past one hundred years and continues to change. Prolactinomas are the most common indication for hypophysectomy. While transsphenoidal hypophysectomy has now become the standard surgical procedure for gaining access to the pituitary fossa, alternative methods of approaching the sphenoid sinus are advocated. A thorough knowledge of sinonasal anatomy is essential for these transsphenoidal procedures, necessitating otolaryngologic consultation. While mortality is low with any of these procedures, the morbidity of the sublabial approach may be avoided with alternative techniques.