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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
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Pituitary transposition techniques: surgical anatomy and technical nuances.
Yuanzhi Xu1, Kumar Abhinav1, Jonathan Rychen1
11Department of Neurosurgery, Stanford Hospital, Stanford.
Journal of Neurosurgery
|July 18, 2025
Summary
This study details seven pituitary transposition techniques for endoscopic endonasal surgery, enhancing access to the retrosellar and interpeduncular regions. Proper technique selection is vital for safe and effective surgical outcomes.
Area of Science:
- Neurosurgery
- Endoscopic Skull Base Surgery
- Surgical Anatomy
Background:
- Endoscopic endonasal approaches offer minimally invasive access to the pituitary gland and surrounding structures.
- Optimal visualization and access to the retrosellar and interpeduncular regions can be challenging.
- Pituitary transposition techniques are crucial for enhancing surgical exposure in these complex anatomical areas.
Purpose of the Study:
- To describe the surgical anatomy and technical nuances of various pituitary transposition techniques.
- To assess the clinical applicability of these techniques for improving safety and efficacy in endonasal skull base surgery.
- To enhance surgical access to the retrosellar and interpeduncular regions.
Main Methods:
- Dissection of 22 silicone-injected cadaveric specimens using an endoscopic endonasal approach.
- Comprehensive evaluation of anatomical landmarks, surgical nuances, and transposition distances for each technique.
- Correlation of techniques with clinical relevance through illustrative case presentations.
Main Results:
- Seven distinct pituitary transposition techniques were established based on dural opening and gland mobilization extent.
- Techniques range from extradural and interdural approaches to intradural hemitransposition, full intradural transposition, and pituitary gland sacrifice.
- Quantified mean vertical and horizontal transposition distances for extradural, interdural transsellar, interdural transcavernous, and extended interdural transcavernous techniques.
Conclusions:
- Seven pituitary transposition techniques are described, categorized by dural opening, gland mobilization, and approach extent.
- The choice of technique should be guided by the specific anatomical regions involved, pathology, and preoperative pituitary function.
- Appropriate selection of pituitary transposition methods is critical for achieving optimal surgical outcomes in endonasal skull base procedures.
