Endoscopic Transsphenoidal Pituitary Surgery
Endoscopic transsphenoidal pituitary surgery is a minimally invasive skull base technique in which pituitary gland tumors are removed through the nose (endonasal), via the sphenoid sinus, with endoscopic guidance. The pituitary region is reached through the floor of the sella turcica without opening the skull.
最后更新: 2026-06-08
Definition
This technique reaches the pituitary gland, located in the midline of the skull base, by passing through the nostrils and opening the sphenoid sinus and the floor of the sella turcica. In many centers the traditional microscopic transsphenoidal approach has been replaced by the endoscopic endonasal technique, which provides angled visualization and broad illumination. It is often performed by combined otolaryngology and neurosurgery teams. It is most commonly used for pituitary adenomas; extended endonasal variants have been described for some skull base pathologies.
Indications
The main indications are non-functioning pituitary adenomas that compress the visual pathways or are enlarging, and hormone-secreting adenomas requiring surgery (for example growth hormone-secreting tumors causing acromegaly and ACTH-secreting tumors causing Cushing disease). In prolactinomas, medical therapy is usually tried first; surgery is considered in selected situations such as resistance or intolerance to medication. The decision rests on combined interpretation of visual examination, endocrine assessment and pituitary-protocol MRI findings.
Procedure
The procedure is performed under general anesthesia; the endoscope is advanced through the nasal cavity to open the sphenoid sinus, and the floor of the sella turcica is removed with fine instruments. After the dura is opened the tumor is removed while attempting to preserve normal pituitary tissue. Neuronavigation, micro-Doppler and, where needed, intraoperative imaging may be used for guidance. At closure the sellar floor is repaired with tissues such as graft, fat or a nasoseptal flap; a multilayer closure may be preferred according to the risk of CSF leak.
Advantages and Limitations
The endonasal endoscopic route offers a wide, angled view of deep midline lesions without opening the skull or retracting brain tissue; it leaves no facial incision and provides comfort for many patients. In contrast, it works within a narrow corridor, has a significant learning curve, and complete removal may not always be possible in large tumors with marked lateral extension, firm consistency or encasement of vascular structures. Some cases may require a transcranial approach or adjunctive treatment (medication, radiotherapy). Suitability varies with the tumor's type, size and extension.
Recovery and Risks
Recovery time varies by patient and tumor. Possible risks include cerebrospinal fluid leak and associated meningitis, transient or permanent hormone deficiencies, diabetes insipidus, involvement of vision or adjacent nerve structures, nasal problems and rare vascular injury. Postoperative endocrine and visual follow-up is required, and the tumor may recur in some cases. No outcome is guaranteed; the decision is made individually by considering the patient's clinical status, hormone profile and imaging findings together.
参考文献
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:861-872.
- Quiñones-Hinojosa A, ed. Schmidek and Sweet: Operative Neurosurgical Techniques. 7th ed. Elsevier; 2021:131-139.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:446.
- Cappabianca P, et al. Endoscopic endonasal transsphenoidal surgery. Neurosurgery. 2004.
本文仅供一般参考，不能替代医疗检查。诊断与治疗决策因人而异。