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Updated: Jun 12, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Postural Change Assists Surgical Maneuverability During Endoscopic Transsphenoidal Surgery for Pituitary Macroadenoma
Yeong Jin Kim1, In-Young Kim1, Sue Jee Park1
1Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun-gun, South Korea.
Background:
In endoscopic transsphenoidal surgery for pituitary adenoma with suprasellar extension, the prolapse of the stretched floppy diaphragma sellae can obstruct the surgical corridor, posing challenges during pituitary surgery. We introduce a simple postural change technique to mitigate this issue and share our clinical experience.
Methods:
Pituitary surgery is performed on an operating table where the patient's position can be adjusted. During transsphenoidal pituitary surgery, raising the patient's head to a Fowler position causes the diaphragma sellae to move upward, whereas lowering the head to a supine position causes it to descend. This simple adjustment minimizes hindrance from the floppy diaphragma sellae during surgery.
Results:
We illustrate this technique in pituitary surgery, where diaphragm sellae relocation is necessary.
Conclusions:
A simple postural change technique effectively manages prolapsed floppy diaphragma sellae, enhancing visualization and surgical accessibility during endoscopic transsphenoidal pituitary surgery.
