Transsphenoidal surgery for pituitary adenomas and other sellar masses
- Brooke Swearingen, MD
Brooke Swearingen, MD
- Professor of Surgery (Neurosurgery)
- Harvard Medical School
Transsphenoidal surgery is the mainstay of treatment for most kinds of pituitary adenomas and other sellar masses. This topic review covers the techniques, results, and complications of transsphenoidal surgery of pituitary adenomas and other sellar masses. The endocrine evaluation of these disorders, as well as options for medical therapy of prolactinomas and acromegaly, are reviewed elsewhere. (See "Causes, presentation, and evaluation of sellar masses" and "Incidentally discovered sellar masses (pituitary incidentalomas)" and "Management of hyperprolactinemia" and "Treatment of acromegaly".)
Transsphenoidal surgery is relatively noninvasive, as it utilizes the nasal passages and sinus anatomy to reach the sella. Successful resection requires that the surgeon:
●Navigate to the sella
●Visualize the tumor through a relatively narrow corridor
●Remove the tumor as completely as possible
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- SURGICAL TECHNIQUES
- - Operating microscope
- - Endoscope
- Resection and repair
- Determination of the extent of resection
- Risks of surgery
- - Experience of the surgeon
- - Hormonal deficiencies
- - Damage to parasellar structures
- Comparison of microscopic versus endoscopic techniques
- Perioperative management
- RESULTS BY TUMOR TYPE
- Lactotroph adenomas
- Somatotroph adenomas (acromegaly)
- Corticotroph adenomas
- Gonadotroph and other clinically nonfunctioning adenomas
- Non-pituitary sellar lesions
- SUMMARY AND RECOMMENDATIONS