Transsphenoidal

Transsphenoidal refers to a surgical approach to the sellar region, most commonly used to access the pituitary gland. The route passes through the nasal cavity and sphenoid sinus to reach the sella turcica, allowing direct access to the pituitary and nearby structures with minimal brain retraction. Transsphenoidal techniques are used for tumor removal, biopsy, and management of other sellar or parasellar pathologies, including craniopharyngiomas, Rathke’s cleft cysts, and certain meningiomas.

Anatomy and technique: The transsphenoidal route traverses the nasal passages, enters the sphenoid sinus, and opens the sellar floor to reach the pituitary gland. Approaches can be microscopic or endoscopic, with endoscopic endonasal methods becoming increasingly common. Extensions may access suprasellar or cavernous sinus regions, depending on tumor extent and skull base anatomy. Preservation of nasal, sphenoidal, and pituitary function is a central consideration.

History and development: The concept originated in the early 20th century and evolved from limited, open approaches to contemporary minimally invasive methods. The development progressed from microscopic transsphenoidal techniques to widespread use of endoscopic and expanded endonasal approaches in the late 20th and early 21st centuries, enhancing visualization and access.

Indications and outcomes: Primary indications include pituitary adenomas and other sellar lesions requiring decompression or tumor reduction. Benefits commonly include reduced brain retraction, shorter recovery, and shorter hospital stays compared with transcranial methods. Potential complications include cerebrospinal fluid leak, meningitis, diabetes insipidus, hypopituitarism, vascular or optic nerve injury, and sinusitis. Not all lesions are amenable to this approach, and some cases require alternative or staged techniques.