Endoscopic transsphenoidal pituitary surgery

Surgical resection constitutes the first line treatment for pituitary adenomas except for prolactinomas which typically respond well to pharmacological therapy. Pituitary adenomas are generally resected via a tanssphenoidal approach. Using endoscopic technique a gross total resection is typically achieved in 90% of microadenomas (diameter < 1 cm). Surgical resection of pituitary macroadenomas (diameter 1 > cm) is facilitated by the use of angled endoscopes in combination with extended approaches. Thus, a gross total resection is achieved in more than two thirds of pituitary macroadenomas. However, once the tumor has invaded the cavernous sinus, gross total resection is only achieved in one third of patients. In functional pituitary adenomas such as prolactinomas, ACTH producing adenomas and growth hormone producing adenomas endocrinological remission is achieved in approximately 80% of patients. Similarly, remission rates decrease once the adenoma has invaded the cavernous sinus. In conclusion, endoscopic transsphenoidal technique allows for gross total resection in the vast majority of patients.