Endoscopic transsphenoidal approaches to the sella

Endoscopic transsphenoidal approaches to the pituitary developed with advances in endoscopic technology. Historically, transsphenoidal approaches to the pituitary transitioned from transcranial to transnasal. Each transnasal approach is associated with distinct advantages, limitations, and complications. The standard endoscopic paraseptal approach is discussed. Modifications of the paraseptal approach balance improved visualization with limited dissection. Endoscopes offer angled visualization of the sellar contents not possible with the binocular microscope. Reconstruction options range from minimal to pedical rotational flaps based on the anatomy of the defect and presence of cerebrospinal fluid (CSF).