The progressive refinement of transsphenoidal pituitary surgery has continued under a minimally invasive endoscopic strategy. The physical advantages of the endoscope allow a transsphenoidal approach through a natural nasal air pathway without the need for a transsphenoidal retractor. The unique optical characteristics of an endoscope provide great advantages in pituitary tumor surgery, particularly for macroadenomas. Wide-angled panoramic views at the posterior wall of the sphenoidal sinus allow clear anatomic orientation in comparison to the limited sellar exposure in conventional microscopic techniques. Angled-lens views allow direct visualization at the suprasellar region or various anatomic corners. Close-up internal views at the tumor resection cavity render minute details at the tumor removal site, allowing further cleansing of any residual crumbs of tumor tissue. There is greater postoperative comfort, more rapid recovery, and shorter hospital stay with endoscopic endonasal surgery than in techniques involving conventional septal dissection through a sublabial or transfixational incision with postoperative nasal packing and intensive-care unit stay. In addition, endoscopic techniques can have particular advantages for the surgical removal of many other types of tumors that could extend to the suprasellar region, invade into the cavernous sinus, project toward the anterior cranial fossa, or extend to the clivus. Although an endoscope can initially be used as an adjunctive tool for the placement of an endonasal transsphenoidal retractor or visualization of anatomic corners during microscopic pituitary surgery, it should widely replace the operating microscope when pituitary surgeons become effectively trained in endoscopic tumor resection and proper instruments are commercially available. Recent advances in endoscopic pituitary adenoma resection are discussed.
*Professor of Neurological Surgery, Director, Jho Institute for Minimally Invasive Neurosurgery, Department of Neurological Surgery, Allegheny General Hospital, Drexel University Medical College, Pittsburgh, Pennsylvania; and †Medical Student, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois.
Dr. Hae-Dong Jho is a consultant for Karl Storz.
Mr. Jho has disclosed that he has no significant financial relatonships with or interests in any commercial company that pertains to this educational activity.
Reprints: Hae-Dong Jho, MD, PhD, Professor of Neurological Surgery, Director, Jho Institute for Minimally Invasive Neurosurgery, Allegheny General Hospital, 7th Floor, Snyder Pavilion, 412 East North Avenue, Pittsburgh, PA 15212. E-mail: DrJho@DrJho.com.
Chief Editor's Note: This article is the 9th of 36 that will be published in 2004 for which a total of up to 36 Category 1 CME credits can be earned. Instructions for how credits can be earned precede the CME Examination at the back of this issue.