Endoscopic Pituitary Surgery

Copyright © 2009 by the Congress of Neurological Surgeons Initially described by Schloffer (21) and Cushing (9) and subsequently popularized by Guiot (12) and Hardy and Wigser (14), the transsphenoidal approach to the sella now represents the preferred approach for removing pituitary adenomas. Traditionally performed with a microscope and a sublabial incision, the implementation of the endoscope and endonasal access has rendered the transsphenoidal approach less invasive and provided improved visualization into and around the sella (4, 5, 16–18). Nevertheless, one of the primary restrictions of endoscopic or endoscopeassisted surgery is the lack of binocular or stereoscopic vision. Monocular endoscopes and displays create a 2-dimensional (2-D) image that impairs depth perception, handeye coordination, and the ability to estimate size (1, 24). Operating in a 2-D environment requires surgeons to train their handeye coordination to respond to visual cues received by the interaction of the operative instruments with the environment to accurately understand the relative depth of structures in the 2-D projection. Surgeons will often move the endoscope in and out or side to side to gain a motion parallax depth cue. This lack of stereoscopic vision has contributed to the steep learning curve in the field of neuroendoscopy. The next obvious step in the evolution of minimal access endoscopic surgery is the development of highdefinition stereoendoscopes that produce a 3-dimensional (3-D) image. Although such stereoendoscopes exist (1, 2, 24), their use in neurosurgery has been limited because of the larger diameter and poor resolution of earlier generations. Hence, only 1 report exists of using stereoendoscopes ABBREVIATIONS: 3-D, 3dimensional; 2-D, 2dimensional THREEDIMENSIONAL ENDOSCOPIC PITUITARY SURGERY