Making the transition from microsurgery to endoscopic trans-sphenoidal pituitary neurosurgery

This article reviews the published experience of others and introduces the authors' insights into the development of an endoscopic pituitary program. While initially challenging, this transition to endoscopic trans-sphenoidal pituitary surgery can yield rewards in the form of superior visualization and potentially more complete tumor resections. With increasing cumulative experience with the endoscopic transsphenoidal technique for pituitary surgery, the improved visualization and less steep learning curve will facilitate more widespread acceptance of endoscopic pituitary surgery as a valid alternative to the trans-septal trans-sphenoidal microscopic approach to pituitary tumors. If not a complete alternative, endoscopic-assisted pituitary surgery will also become more widespread, as endoscopy can easily supplement standard microscopic approaches to pituitary tumors. As transnasal endoscopic approaches to the skull base are increasingly refined in technology and skill, additional applications of this technology may permit skull base approaches through the planum sphenoidale and tuberculum sellae for the removal of giant suprasellar macroadenomas that may otherwise require an open craniotomy for surgical management. The collaboration between otolaryngologists and neurosurgeons is important for further developing successful endoscopic trans-sphenoidal pituitary surgery and improving care for patients. Objective evidence is needed to validate whether the improved visualization results in superior patient outcomes and reduced clinical complications, and if this technique can be reasonably taught in a controlled, supervised setting in residency training programs. Additional outcomes data are needed to evaluate long-term outcomes and define the boundaries of endoscopic trans-sphenoidal pituitary surgery.