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Updated: Jan 7, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
The efficacy of minimally invasive intraoperative ultrasound in endoscopic pituitary surgery
Min Ho Lee1, Yeon Hee Im2, Ji-Hyeon Shin3
1Department of Neurosurgery, Uijeongbu St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. minho919.lee@catholic.ac.kr.
Objective:
This study aims to evaluate the clinical utility of minimally invasive intraoperative ultrasound as a real-time imaging adjunct during endoscopic endonasal pituitary adenoma surgery. The goal is to determine its effectiveness in tumor localization, identification of critical structures, and detection of residual tumor tissue.
Methods:
A retrospective analysis was conducted on 22 patients who underwent endoscopic endonasal pituitary surgery with intraoperative ultrasound at our institution from August 2024 to June 2025. The ultrasound probe was used before dural opening to identify the tumor, normal gland, and adjacent structures, including the internal carotid artery (ICA). After tumor resection, ultrasound was employed to assess residual tumor. Clinical and surgical outcomes, including extent of resection and perioperative complications, were reviewed.
Results:
Intraoperative ultrasound enabled clear visualization of the tumor-normal gland interface in both solid and cystic macroadenomas, facilitating safe and precise resection. The technique aided in identification of the ICA during cavernous sinus invasion, reducing vascular injury risk. In cases where tumors were not visible on preoperative magnetic resonance imaging (MRI), intraoperative ultrasound successfully detected the lesions, allowing targeted resection. Gross total resection (GTR) was achieved in 86.4% of cases. The median follow-up was 8 months (range, 3-13 months). There were no new postoperative hormonal deficits. Transient diabetes insipidus occurred in three cases, and all resolved within three months.
Conclusion:
Intraoperative ultrasound provides real-time, high-resolution imaging that enhances the precision and safety of endoscopic pituitary surgery. The technique is particularly valuable for tumor localization, identification of critical neurovascular structures, and detection of residual tumor tissue. Further studies are warranted to validate a broader applicability and refine its role in differentiating tumor from normal gland tissue.
