Endoscopic pituitary surgery

Endoscopic surgery for pituitary surgery is gaining acceptance. In the past few years, there have been several reports on this technique. At his institution, the lead author (D.S.S.) has been using the endoscope for pituitary surgery for the past 12 years. The initial approach was transeptal. This technique required a hemi-transfixion incision, and the surgery was performed using endoscopes through a midline tunnel created by elevating bilateral mucoperichondrial flaps and a midline sphenoidotomy. Although the endoscope provided excellent illumination and visualization of the operative field, working in the narrow midline tunnel had its limitations. The main difficulty was the inability of 2 surgeons to be able to work at the same time during tumor removal. The authors describe a modification of his technique that uses a wide midline sphenoidotomy created by connecting the bilateral sphenoidotomies in the midline.