There are three general surgical approaches for pituitary adenomas in China and abroad: microscopic transnasal-disc approach, endoscopic transnasal-disc approach, and direct craniotomy.
Direct craniotomy is rarely used to remove pituitary adenomas, but mainly for those with large tumors or those with large residual tumors after transnasal-disc surgery. The advantages of direct craniotomy are that it can be performed under direct vision and can effectively avoid important nerves and vascular tissues, such as optic nerve and internal carotid artery. The disadvantages are large craniotomy injury, stretching brain tissue, difficulty in reaching tumors in the pterygoid saddle and pterygoid sinus, long postoperative recovery time and high cost.
The microscopic transnasal-disc approach and endoscopic transnasal-disc approach are both minimally invasive approaches.
The microscopic transnasal-disc approach is the traditional and classical way to remove pituitary adenoma, with the advantages of less trauma, shorter operation time and lower cost than the open approach. In particular, the microscopic single nostril transdiscal approach, led by Prof. Wei Shaobo in China, is minimally invasive, which greatly reduces the operation time, hospital stay and treatment cost, and has good efficacy. The disadvantage is that the field of view is limited for invasive pituitary adenoma.
The endoscopic transnasal disc approach, which is a new and more popular surgical approach, is essentially a type of minimally invasive surgery, with the advantage of being minimally invasive and the disadvantage of a long operative time and relative difficulty in intraoperative hemostasis.