REVIEWS   

Otorinolaringologia 2009 June;59(2):97-105

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

A review of minimally invasive pituitary surgery: the evolution from maximally to minimally invasive surgery

Ebert C. S., Senior B. A.

Division of Rhinology, Allergy, and Sinus Surgery Department of Otolaryngology-Head and Neck Surgery University of North Carolina at Chapel Hill Chapel Hill, NC, USA

Over the last 100 years, a variety of surgical procedures have been described to approach the pituitary. When analyzing the current renaissance of endonasal pituitary surgery, it is important to review the historic and anatomic development of thought that has led to the current technological advances and improved patient care. With the marriage of the endoscope to the trans-sphenoidal approach, shorter operative times, decreased blood loss, improved differentiation between normal tissue and tumor, better visualization of intrasellar and parasellar structures, shorter hospital stays, improved patient satisfaction, and decreased need for nasal packing have all been seen. Furthermore, this marriage has brought together the otolaryngologist and the neurosurgeon into a true surgical team, thereby helping to advance new concepts such as extracapsular tumor dissection as well as new ways to explore the tumor bed and optimize tumor resection with angled views and hydroscopy. Continued surgical innovation and technological gains will continue to allow otolaryngologist/neurosurgeon skull base surgeons to push the minimally invasive envelope beyond the sella to other regions of the anterior, middle, and posterior fossae.