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Transsphenoidal surgery on the pituitary

M B Allen, T el Gammal, M D Nathan

The American Surgeon

|July 1, 1981

Summary

Transseptal transsphenoidal hypophysectomy is a safe procedure for select patients, with improved preoperative imaging enhancing its applicability. However, caution is advised for pituitary tumors with large suprasellar extensions.

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Area of Science:

Neurosurgery
Endocrinology
Otolaryngology

Background:

Transseptal transsphenoidal hypophysectomy has advanced significantly, becoming a procedure with low mortality and morbidity in carefully chosen patients.
Computerized axial tomography (CT) advancements have improved preoperative evaluation accuracy for pituitary surgeries.

Purpose of the Study:

To highlight the evolving safety and broadening indications for transsphenoidal approaches to the sella.
To emphasize the need for caution when using the transsphenoidal route for pituitary tumors with extensive suprasellar components.

Main Methods:

Review of surgical outcomes and indications for transseptal transsphenoidal hypophysectomy.
Analysis of the impact of advanced neuroimaging, specifically CT, on preoperative patient selection and surgical planning.

Main Results:

The procedure is associated with low mortality and morbidity in appropriately selected patient cohorts.
Improved preoperative imaging facilitates broader application of transsphenoidal techniques.
Extensive suprasellar extension of pituitary tumors presents a challenge for the transsphenoidal approach.

Conclusions:

Transseptal transsphenoidal hypophysectomy is a viable and safe surgical option for select pituitary adenomas.
The indications for this minimally invasive approach are expanding due to improved diagnostic capabilities and surgical safety.
Careful patient selection and consideration of tumor extent, particularly suprasellar involvement, are crucial for successful outcomes.

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