Microscopic Transsphenoidal Surgery in the Era of Endoscopy: Are There Any Advantages?

Developed over 50 years ago, the microscopic transsphenoidal approach is a simple, efficient technique with proven efficacy for the surgical treatment of an array of sellar and parasellar diseases. Although utilization of fully endoscopic transsphenoidal approaches has dramatically increased recently because it offers enhanced visualization, current outcomes data do not clearly favor either approach. Potential advantages of the microscope that persist in the endoscopic era include decreased operative time; preservation of a single-surgeon, unobstructed, twohanded microsurgical technique; and limited disruption of the nasal mucosa. Endoscope-assisted microsurgical approaches can also be used to overcome limitations in visualization while preserving the aforementioned advantages.