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.
- 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.
- 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.