Transsphenoidal Approaches: Microscopic

  • Ian F. Dunn
  • Edward R. Laws


Shaped by the brilliant insight of individual surgeons and technological innovation, the microscopic transsphenoidal approach to the sellar and parasellar regions is a fascinating chronicle in surgical history whose evolution continues unabated. Indeed, although subtemporal, transfacial, and frontal transcranial routes were propounded at the turn of the 20th century, only the transsphenoidal route has endured as the preferred approach to the overwhelming majority of sellar and parasellar lesions.


Pituitary Adenoma Cavernous Sinus Sphenoid Sinus Transsphenoidal Surgery Transsphenoidal Approach 


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  1. 1.
    Kanter AS, Dumont AS, Asthagiri AR et al (2005) The transsphenoidal approach. A historical perspective. Neurosurg Focus 18:e6CrossRefPubMedGoogle Scholar
  2. 2.
    Schloffer H (1907) Erfolgreiche Operationen eines Hypophysentumors auf Nasalem Wege. Wien Klin Wochenschr 20:621–624Google Scholar
  3. 3.
    von Eiselsberg A (1908) The operative cure of acromegaly by removal of a hypophysial tumor. Ann Surg 48:781–783Google Scholar
  4. 4.
    Kocher T (1909) Ein Fall von Hypophysis-Tumor mit operativer Heilung. Dtsch Z Chir 100:13–37Google Scholar
  5. 5.
    Lanzino G, Laws ER Jr (2003) Key personalities in the development and popularization of the transsphenoidal approach to pituitary tumors: an historical overview. Neurosurg Clin North Am 14:1–10CrossRefGoogle Scholar
  6. 6.
    Halstead AE (1910) Remarks on the operative treatment of tumors of the hypophysis. With the report of two cases operated on by an oro-nasal method. Trans Am Surg Assoc 28:73–93Google Scholar
  7. 7.
    Cushing H (1914) The Weir Mitchell Lecture. Surgical experiences with pituitary adenoma. JAMA 63:1515–1525Google Scholar
  8. 8.
    Jane JA Jr, Han J, Prevedello DM et al (2005) Perspectives on endoscopic transsphenoidal surgery. Neurosurg Focus 19:E2CrossRefPubMedGoogle Scholar
  9. 9.
    Elias WJ, Laws ER (2000) Transsphenoidal approaches to lesions of the sella. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques: indications, methods, and results. W.B. Saunders, Philadelphia, pp 373–384Google Scholar
  10. 10.
    Jane JA Jr, Dumont AS, Sheehan JP, Laws ER (2004) Surgical techniques in transsphenoidal surgery: what is the standard of care in pituitary adenoma surgery? Current Opin Endocrinol Diabetes 14:264–270CrossRefGoogle Scholar
  11. 11.
    Wilson WR, Khan A, Laws ER Jr (1990) Transseptal approaches for pituitary surgery. Laryngoscope 100:817–819PubMedGoogle Scholar
  12. 12.
    Kern EB, Pearson BW, McDonald TJ, Laws ER Jr (1979) The transseptal approach to lesions of the pituitary and parasellar regions. Laryngoscope 89:1–34CrossRefPubMedGoogle Scholar
  13. 13.
    Laws ER Jr (1999) Vascular complications of transsphenoidal surgery. Pituitary 2:163–170CrossRefPubMedGoogle Scholar
  14. 14.
    Griffith HB, Veerapen R (1987) A direct transnasal approach to the sphenoid sinus. Technical note. J Neurosurg 66:140–142CrossRefPubMedGoogle Scholar
  15. 15.
    Jane JA Jr, Thapar K, Kaptain GJ et al (2002) Pituitary surgery: transsphenoidal approach. Neurosurgery 51:435–442CrossRefPubMedGoogle Scholar
  16. 16.
    Wilson WR, Laws ER Jr (1992) Transnasal septal displacement approach for secondary transsphenoidal pituitary surgery. Laryngoscope 102:951–953CrossRefPubMedGoogle Scholar
  17. 17.
    Zada G, Kelly DF, Cohan P et al (2003) Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions. J Neurosurg 98:350–358CrossRefPubMedGoogle Scholar
  18. 18.
    Elias WJ, Chadduck JB, Alden TD, Laws ER Jr (1999) Frameless stereotaxy for transsphenoidal surgery. Neurosurgery 45:271–275CrossRefPubMedGoogle Scholar
  19. 19.
    Jane JA Jr, Thapar K, Alden TD, Laws ER Jr (2001) Fluoroscopic frameless stereotaxy for transsphenoidal surgery. Neurosurgery 48:1302–1307CrossRefPubMedGoogle Scholar
  20. 20.
    McCutcheon IE, Kitagawa RS, Demasi PF et al (2004) Frameless stereotactic navigation in transsphenoidal surgery: comparison with fluoroscopy. Stereotact Funct Neurosurg 82:43–48CrossRefPubMedGoogle Scholar
  21. 21.
    Jagannathan J, Prevedello DM, Ayer VS et al (2006) Computer-assisted frameless stereotaxy in transsphenoidal surgery at a single institution: review of 176 cases. Neurosurg Focus 20:E9CrossRefPubMedGoogle Scholar
  22. 22.
    Dusick JR, Esposito F, Malkasian D, Kelly DF (2007) Avoidance of carotid artery injuries in transsphenoidal surgery with the Doppler probe and micro-hook blades. Neurosurgery 60:322–328CrossRefPubMedGoogle Scholar
  23. 23.
    Fahlbusch R, Ganslandt O, Buchfelder M et al (2001) Intraoperative magnetic resonance imaging during transsphenoidal surgery. J Neurosurg 95:381–390CrossRefPubMedGoogle Scholar
  24. 24.
    Martin CH, Schwartz R, Jolesz F, Black PM (1999) Transsphenoidal resection of pituitary adenomas in an intraoperative MRI unit. Pituitary 2:155–162CrossRefPubMedGoogle Scholar
  25. 25.
    Nimsky C, von Keller B, Ganslandt O, Fahlbusch R (2006) Intraoperative high-field magnetic resonance imaging in transsphenoidal surgery of hormonally inactive pituitary macroadenomas. Neurosurgery 59:105–114CrossRefPubMedGoogle Scholar
  26. 26.
    Yamasaki T, Moritake K, Hatta J, Nagai H (1996) Intraoperative monitoring with pulse Doppler ultrasonography in transsphenoidal surgery: technique application. Neurosurgery 38:95–97CrossRefPubMedGoogle Scholar
  27. 27.
    Hall WA, Kowalik K, Liu H et al (2003) Costs and benefits of intraoperative MR-guided brain tumor resection. Acta neurochirurgica 85:137–142PubMedGoogle Scholar
  28. 28.
    Sharma K, Tyagi I, Banerjee D et al (1996) Rhinological complications of sublabial transseptal transsphenoidal surgery for sellar and suprasellar lesions: prevention and management. Neurosurg Rev 19:163–167CrossRefPubMedGoogle Scholar
  29. 29.
    Sherwen PJ, Patterson WJ, Griesdale DE (1986) Transseptal, transsphenoidal surgery: a subjective and objective analysis of results. J Otolaryngol 15:155–160PubMedGoogle Scholar
  30. 30.
    Spencer WR, Levine JM, Couldwell WT et al (2000) Approaches to the sellar and parasellar region: a retrospective comparison of the endonasal-transsphenoidal and sublabialtranssphenoidal approaches. Otolaryngol Head Neck Surg 122:367–369CrossRefPubMedGoogle Scholar
  31. 31.
    Liu JK, Nwagwu C, Pikus HJ, Couldwell WT (2001) Laparoscopic anterior lumbar interbody fusion precipitating pituitary apoplexy. Acta Neurochir (Wien) 143:303–306CrossRefGoogle Scholar
  32. 32.
    Kerr PB, Oldfield EH (2008) Sublabial-endonasal approach to the sella turcica. J Neurosurg 109:153–155CrossRefPubMedGoogle Scholar
  33. 33.
    Ellegala DB, Maartens NF, Laws ER Jr (2002) Use of FloSeal hemostatic sealant in transsphenoidal pituitary surgery: technical note. Neurosurgery 51:513–515CrossRefPubMedGoogle Scholar
  34. 34.
    Park J, Guthikonda M (2004) The Medpor sheet as a sellar buttress after endonasal transsphenoidal surgery: technical note. Surg Neurol 61:488–492CrossRefPubMedGoogle Scholar
  35. 35.
    Cavallo LM, Messina A, Esposito F et al (2007) Skull base reconstruction in the extended endoscopic transsphenoidal approach for suprasellar lesions. J Neurosurg 107: 713–720CrossRefPubMedGoogle Scholar
  36. 36.
    Couldwell WT, Weiss MH, Rabb C et al (2004) Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery 55:539–547CrossRefPubMedGoogle Scholar
  37. 37.
    Dumont AS, Kanter AS, Jane JA Jr, Laws ER Jr (2006) Extended transsphenoidal approach. Front Horm Res 34:29–45CrossRefPubMedGoogle Scholar
  38. 38.
    Kouri JG, Chen MY, Watson JC, Oldfield EH (2000) Resection of suprasellar tumors by using a modified transsphenoidal approach. Report of four cases. J Neurosurg 92:1028–1035CrossRefPubMedGoogle Scholar
  39. 39.
    Weiss MH (ed) (1987) Transnasal transsphenoidal approach. Williams and Wilkins, BaltimoreGoogle Scholar
  40. 40.
    Cappabianca P, Cavallo LM, Colao A et al (2002) Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invasive Neurosurg 45:193–200CrossRefPubMedGoogle Scholar
  41. 41.
    de Divitiis E, Cappabianca P, Cavallo LM (2002) Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesions. Neurosurgery 51:699–705CrossRefPubMedGoogle Scholar
  42. 42.
    Frank G, Pasquini E, Mazzatenta D (2001) Extended transsphenoidal approach. J Neurosurg 95:917–918PubMedGoogle Scholar
  43. 43.
    Jho HD, Ha HG (2004) Endoscopic endonasal skull base surgery: Part 1—The midline anterior fossa skull base. Minim Invasive Neurosurg 47:1–8CrossRefPubMedGoogle Scholar
  44. 44.
    Kato T, Sawamura Y, Abe H, Nagashima M (1998) Transsphenoidal-transtuberculum sellae approach for supradiaphragmatic tumours: technical note. Acta Neurochir (Wien) 140:715–718CrossRefGoogle Scholar
  45. 45.
    Kaptain GJ, Vincent DA, Sheehan JP, Laws ER Jr (2008) Transsphenoidal approaches for the extracapsular resection of midline suprasellar and anterior cranial base lesions. Neurosurgery 62:1264–1271CrossRefPubMedGoogle Scholar
  46. 46.
    Nemergut EC, Zuo Z, Jane JA Jr, Laws ER Jr (2005) Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J Neurosurg 103:448–454CrossRefPubMedGoogle Scholar
  47. 47.
    Ciric I, Ragin A, Baumgartner C, Pierce D (1997) Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40:225–236CrossRefPubMedGoogle Scholar
  48. 48.
    Oskouian RJ, Kelly DF, Laws ER Jr (2006) Vascular injury and transsphenoidal surgery. Front Horm Res 34:256–278CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2010

Authors and Affiliations

  • Ian F. Dunn
    • 1
  • Edward R. Laws
    • 1
  1. 1.Dept of NeurosurgeryBrigham and Women’s Hospital Harvard Medical SchoolBostonUSA

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