Transnasal Endoscopic Pituitary Surgery: Indications, Technique, and Complications

Abstract

Pituitary neoplasm is the commonest sellar pathology, where pituitary adenoma heads the list, it accounts for 25% of all intracranial neoplasm. Although it is a benign lesion in most cases is located in a complex region; adjacent to important structures: optic chiasm, internal carotid arteries, suprasellar cistern, and cavernous sinuses, it presents with a variety of clinical scenarios. The Sella is situated at the center of the skull base, this made surgical access via craniotomy very challenging and is associated with considerable morbidity. Transnasal endoscopic pituitary surgery (TEPS) evolved rapidly, almost replacing the craniotomy approach, because it is minimally invasive and gives direct sellar access with excellent visualization. On the other hand, the learning curve of TEPS requires meticulous training to acquire surgical skills. Indications of TEPS, technique, complications, their prevention, and management are described. The multidisciplinary approach in managing pituitary adenoma is addressed, where a team of an endocrinologist, neurosurgeon, otolaryngologist, ophthalmologist, anesthesiologist, and neuroradiologist decide on a management plan for patients. Other disciplines share management of certain cases that is Oncologist, ICU specialists, and obstetrician. Long term follow-up is required by endocrinologists whereas revision surgery is considered in some patients.