Introduction

In the long history of the transsphenoidal approach to the sella turcica, the use of neuroendoscopy as the sole means of visualization and surgical resection of pituitary lesions is a relatively recent technique. Despite its relatively short existence, however, this technique has been extensively refined and has become commonplace in many operating rooms around the world.

The neuroendoscopic approach to pituitary lesions has been shown in numerous studies to have tumor resection and hormonal remission rates equal to or better than the classic microsurgical transsphenoidal technique. Furthermore, the rate of complications associated with neuroendoscopic procedures has been shown to be equal to if not less than those reported from series of microsurgical procedures. The use of the endoscope for transsphenoidal surgery has provided improvements in panoramic visualization, the ability to use angled lenses to look around anatomic “corners,” improved illumination, and has facilitated the development of extended approaches to the skull base. The future of neuroendoscopic resection of pituitary lesions lies in the continued miniaturization and innovation of endoscopic instrumentation, advances in optical technology, and improved visualization systems.

The endonasal endoscopic transsphenoidal technique consists of four major stages: nasal, sphenoid, sellar stage, and reconstruction. In the nasal stage, the endoscope is advanced through the nasal cavity to identify the sphenoid ostium, followed by a posterior septectomy and anterior sphenoidotomy. The sphenoid stage is characterized by widening of the anterior sphenoidal exposure, removal of the sphenoid septa, and identification of key landmarks surrounding the sellar floor. The sellar stage involves removal of the bony sellar floor, dural opening, and surgical treatment of the pathologic lesion. Finally, in the reconstruction stage, prevention or repair of cerebrospinal fluid (CSF) leaks is addressed.