Pituitary tumor surgery includes both craniotomy and transnasal butterfly surgery. The choice of craniotomy or transnasal butterfly surgery depends on the size of the tumor, the main growth direction, and the invasion of surrounding structures, and some patients need a combination of both surgical approaches to achieve better surgical results.
Currently, most pituitary tumors can be removed by transnasal butterfly surgery, including transnasal butterfly microscopic surgery and endoscopic surgery. Compared with direct microscopic surgery, endoscopy has a surgical view of more than 70 degrees and a wide observation range, which increases the rate of total tumor resection and the protection of normal vascular and neural structures. However, some large pituitary tumors that grow mainly in the suprasellar direction and invade structures such as the encircling internal carotid artery require craniotomy to separate and protect important vascular nerves under direct vision. Some huge pituitary tumors may require craniotomy to remove part of the suprasellar tumor and then part of the saddle via nasal butterfly, and often require repair of the saddle base to prevent cerebrospinal fluid nasal leakage.