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John A. Jane Jr., Erin Kiehna, Spencer C. Payne, Stephen V. Early and Edward R. Laws Jr.

require a more conservative approach consisting of limited resection followed by radiation therapy or intracavitary therapies. A subset of tumors may also be managed using a transsphenoidal approach. The transsphenoidal approach for craniopharyngiomas is widely accepted for intrasellar craniopharyngiomas. Select centers have also advocated the transsphenoidal route for tumors with subdiaphragmatic origin and subsequent suprasellar extension. 1 , 19 , 20 These subdiaphragmatic craniopharyngiomas are thought to be more easily removed by a transsphenoidal approach

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Namath S. Hussain, Mackenzie Piper, W. Grant Ludlam, William H. Ludlam, Cindy J. Fuller and Marc R. Mayberg

data: Mayberg, Hussain, Fuller. Drafting the article: all authors. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: Mayberg. Statistical analysis: Fuller. References 1 Adams JR , Blevins LS Jr , Allen GS , Verity DK , Devin JK : Disorders of water metabolism following transsphenoidal pituitary surgery: a single institution's experience . Pituitary 9 : 93 – 99 , 2006 2 Albanese A , Hindmarsh P , Stanhope R

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Simona Mihaela Florea, Thomas Graillon, Thomas Cuny, Regis Gras, Thierry Brue and Henry Dufour

P ituitary tumors, either functioning or nonfunctioning, are common lesions that account for approximately 10%–15% of all intracranial primary tumors. 19 They are the third most frequent primary intracranial lesion after gliomas and meningioma. 19 In the majority of cases, these tumors are benign. For many years, surgical treatment was the primary treatment of pituitary adenoma. A shift in technique preferences began in the first years of the 1990s, as the endoscopic transsphenoidal approach was progressively adopted in most of the specialized centers

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Jackson A. Gondim, João Paulo Almeida, Lucas Alverne F. de Albuquerque, Erika Gomes, Michele Schops and Jose Italo Mota

undergo transsphenoidal surgery for removal of PA, demonstrating the benefits of this approach in selected patients. 2 , 6 , 17 , 22 , 24 , 41 When compared with microscopic transsphenoidal surgery, endoscopic endonasal approaches may be more aggressive, with exposure and resection of lateral extensions and manipulation of the suprasellar and parasellar regions, which is especially important in young patients with a long life expectancy, in contrast to the elderly. In such a way, endoscopic approaches, in theory, could lead to extended tumor resection but also to a

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Edward R. Laws, Judith M. Wong, Timothy R. Smith, Kenneth de los Reyes, Linda S. Aglio, Alison J. Thorne, David J. Cote, Felice Esposito, Paolo Cappabianca and Atul Gawande

S urgical complications have long been a major and well-documented source of morbidity and mortality. In the earliest days of neurosurgery, mortality rates reached as high as 80% for some operations, and complications were exceedingly common. 24 Even in the best of hands, the transsphenoidal approach to the skull base had mortality rates as high as 5.6% in the early 1900s. 20 Subsequently, there has been a significant decline in complication and mortality rates as a result of the vast expansion of medical knowledge, improved technologies, and higher

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Robert E. Decker and Robert Carras

D elayed progressive visual impairment occurring after both transcranial and transsphenoidal surgery for pituitary adenoma has been described. 3, 5–7 Traction injury of the optic chiasm and its prevention and correction have been amply documented by Olson, et al. 4 We are reporting a case of posthypophysectomy visual loss that probably occurred because of a deficient diaphragma sellae and a deviation from our usual method of repair of the sella turcica floor. Case Report A 60-year-old woman with known carcinoma of the breast metastatic to the

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Carrie L. Pledger, Mohamed A. Elzoghby, Edward H. Oldfield, Spencer C. Payne and John A. Jane Jr.

T he transsphenoidal resection of pituitary adenomas is performed using either an endoscope or a microscope. 2 , 3 Advantages of the endoscopic approach include an improved view of the anatomy, a wider view inside the sella, and a greater working area. By contrast, the microscopic approach allows for high-resolution imaging and improved visualization of extremely small microadenomas. 23 Use of the endoscope is thought to provide the patient with fewer postoperative symptoms and less pain as well as a quicker recovery. While some authors have argued that

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Timothy R. Smith, M. Maher Hulou, Kevin T. Huang, Breno Nery, Samuel Miranda de Moura, David J. Cote and Edward R. Laws

, treatment, and vigilant monitoring are crucial. If left unchecked, the combined clinical manifestations of CD increase a person's risk for increased illness and/or death while substantially reducing quality of life. The transsphenoidal approach for resection of corticotrophsecreting adenomas is associated with a high percentage of disease remission. 46 , 55 , 63 After surgical treatment, some patients may experience persistent subclinical CD that remains difficult to detect with routine testing. 28 Complications (e.g., CSF leakage, deteriorated vision, epistaxis

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Ben A. Strickland, Joshua Lucas, Brianna Harris, Edwin Kulubya, Joshua Bakhsheshian, Charles Liu, Bozena Wrobel, John D. Carmichael, Martin Weiss and Gabriel Zada

T he transsphenoidal approach to the sellar region has long stood as the primary method used to access the pituitary gland, due to its high efficacy and low morbidity rate, even with large lesions. 6 , 7 Although rates of morbidity associated with this technique have improved significantly over the last decade, complication rates can be as high as 22%. 22 One of the most common complications associated with transsphenoidal surgery is cerebrospinal fluid (CSF) leakage. 2 Recently, improved repair techniques have improved the incidence of postoperative CSF

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Daniel Wilson, Diana L. Jin, Timothy Wen, John D. Carmichael, Steven Cen, William J. Mack and Gabriel Zada

C ushing's disease (CD) is caused by a pituitary tumor secreting excess adrenocorticotropic hormone, resulting in downstream overproduction of cortisol. Adrenocorticotropic hormone–secreting pituitary adenomas are typically benign, and the mainstay of treatment in newly diagnosed patients with CD is transsphenoidal surgery (TSS). 1 , 3–5 , 7–9 , 12–14 Following successful tumor resection, patients may ultimately regain normal pituitary function and experience long-term hormonal remission or even cures. 10 Medical and radiation-based therapies for CD are