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The Direct Endoscopic Endonasal Transsphenoidal Approach to the Pituitary Gland

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Atlas of Sellar and Parasellar Lesions

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Abstract

Over the past two decades, the endoscopic endonasal transsphenoidal approach to the pituitary gland and sellar region for the treatment of pituitary pathology has evolved rapidly. The direct endoscopic endonasal transsphenoidal approach consists of a nasal stage, a sphenoid stage, a sellar stage, and a reconstruction stage. Integration of the endoscope into pituitary surgery affords the surgeon superior panoramic visualization and illumination compared with the traditional microscopic approach. Additionally, the endoscopic approach facilitates two-handed surgical microdissection and the ability to look around anatomic surgical corners using angled lenses, which in turn may promote maximal tumor resection and preservation of the normal pituitary gland. This chapter focuses on key anatomic landmarks and operative strategies pertaining to the direct endoscopic endonasal approach to the sella. Continued experience and familiarity with the endoscopic transsphenoidal approach, combined with technologic advancements and improved instrumentation, are likely to contribute to improved surgical outcomes in the future.

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Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 N State Street, #3300, Los Angeles, CA, 90033, USA

    Gabriel Zada MD, MS

  2. Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Joshua W. Lucas MD

  3. Department of Neurosurgery, Brigham and Women’s Hospital, 15 Francis Street, Boston, MA, 02115, USA

    Edward R. Laws Jr. MD

Authors
  1. Gabriel Zada MD, MS
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  2. Joshua W. Lucas MD
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  3. Edward R. Laws Jr. MD
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Corresponding author

Correspondence to Gabriel Zada MD, MS .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, University of Southern California, LOS ANGELES, California, USA

    Gabriel Zada

  2. Department of Pathology, University of Virginia, CHARLOTTESVILLE, Virginia, USA

    M. Beatriz S. Lopes

  3. Department of Radiology, Brigham and Women's Hospital, BOSTON, Massachusetts, USA

    Srinivasan Mukundan Jr.

  4. Department of Neurosurgery, Brigham and Women’s Hospital, BOSTON, Massachusetts, USA

    Edward R. Laws Jr.

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© 2016 Springer International Publishing Switzerland

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Zada, G., Lucas, J.W., Laws, E.R. (2016). The Direct Endoscopic Endonasal Transsphenoidal Approach to the Pituitary Gland. In: Zada, G., Lopes, M., Mukundan Jr., S., Laws Jr., E. (eds) Atlas of Sellar and Parasellar Lesions. Springer, Cham. https://doi.org/10.1007/978-3-319-22855-6_5

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  • DOI: https://doi.org/10.1007/978-3-319-22855-6_5

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22854-9

  • Online ISBN: 978-3-319-22855-6

  • eBook Packages: MedicineMedicine (R0)

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