Pituitary Surgery

Target Pituitary

Transsphenoidal Surgery

Although the transsphenoidal approach is over 100 years old, it remains a highly effective, minimally invasive technique for the removal of pituitary tumors. Recent advances in the technique include the addition of neuronavigational devices, the endoscopic approach, and the intraoperative MRI.

Pituitary Tumor Surgery

Target Pituitary

Surical Approaches to the Pituitary

APPROACH - There are two transsphenoidal approaches to the pituitary in current use today. Both of them access the pituitary through the sphenoid sinus and are considered transsphenoidal approaches.

  1. The surgeon can make an incision under the lip, called the sublabial approach. This gives the surgeon a wide view, but the lip incision is painful and can lead to numbness of the teeth and gums.
  2. The endonasal approach, which we use at MGH, requires an incision in the back of the nasal passage which leads directly into the sphenoid sinus. With this approach, nasal packing is not required.
    • In rare cases, the pituitary tumor is so large that it cannot be approached transsphenoidally, and a craniotomy is required.

VISUALIZING THE TUMOR - The surgeon can visualize the tumor either through the microscope or through the endoscope. The microscope provides superb optics with a narrower field of view; the endoscope provides a wider field of view but usually does not provide binocular vision. At MGH, we use a combination of the two techniques, depending upon the anatomy and size of the tumor.

INTRAOPERATIVE IMAGING - Because the access to the pituitary tumor is relatively limited, it is sometimes difficult to determine the adequacy of resection. One approach has been to perform MRI imaging during the operation, in order to visualize possible residual tumor. This technique, available at MGH, allows the surgeon to maximize the extent of resection.

Disclaimer About Medical Information: The information and reference materials contained herein is intended solely for the information of the reader. It should not be used for treatment purposes, but rather for discussion with the patient's own physician. All visitors to this and associated sites from the Neurosurgical Service at MGH agree to read and abide by the the complete terms of legal agreement found at the Neurosurgery "disclaimer & legal agreements."

Physicians' Pituitary Information Service - Physicians with questions may contact Dr Biller or Dr Klibanski at 617.726.3965 or 1.888.429.6863 or via e-mail at - pituitary.info@partners.org :: Research Studies

The Neuroendocrine and Pituitary Tumor Clinical Center
Massachusetts General Hospital
Zero Emerson Place, Suite 112, Boston, Massachusetts 02114
Voice: 617.726.7948 & Fax: 617.726.1241
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