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Transsphenoidal surgery for pituitary adenomas and other sellar masses

Brooke Swearingen, MD
Section Editor
Peter J Snyder, MD
Deputy Editor
Kathryn A Martin, MD


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".)


Anesthetic concerns for patients who undergo transsphenoidal surgery are most significant for patients who have secretory lesions (ie, patients with acromegaly and Cushing's disease). In addition, patients with hormonal deficiencies (eg, hypothyroidism) should be identified and, if necessary, treated preoperatively. (See 'Perioperative management' below.)

Airway management may be difficult in patients with acromegaly and Cushing's disease because of anatomic distortion. Importantly, airway evaluation using the usual metrics (eg, Mallampati classification, mouth opening, neck range of motion, thyromental distance) may be falsely reassuring in patients with acromegaly (table 1 and table 2 and table 3 and table 4) [1]. Equipment and personnel for difficult airway management should be immediately available during induction of anesthesia for these patients. Awake intubation may be the best option in severely affected patients. (See "Management of the difficult airway for general anesthesia".)

For acromegalic patients with severe airway compromise, it may be advisable to pre-treat the patient with a somatostatin analog or growth hormone receptor antagonist for a few months prior to planned surgery, in an attempt to minimize airway edema and facilitate safe intubation. Similarly, those acromegalic patients with significant cardiomyopathy may benefit from pre-treatment in an attempt to improve cardiac function before undergoing transsphenoidal surgery. (See 'Somatotroph adenomas (acromegaly)' below.)

Patients with acromegaly and Cushing's disease are at increased risk of hypertension and cardiovascular disease, obstructive sleep apnea, diabetes, and other manifestations that may affect anesthetic care. (See "Epidemiology and clinical manifestations of Cushing's syndrome", section on 'Clinical manifestations' and "Causes and clinical manifestations of acromegaly", section on 'Clinical manifestations'.)

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Literature review current through: Dec 2017. | This topic last updated: Sep 19, 2017.
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