Pituitary adenoma is the most common type of saddle lesion in adults.
Clinically, it can present with headache, visual field loss, amenorrhea and overflow, cold and weakness, and sexual dysfunction. Patients with visual field defects or those who fail to respond to medication usually require surgery, and may require emergency surgery if accompanied by tumor bleeding.
With the development of neurosurgical techniques and corresponding instruments and equipment, the surgical treatment of pituitary tumors has been continuously improved. The surgical approach has undergone an evolution from craniotomy to transnasal butterfly approach.
Transsphenoidal surgery is a minimally invasive surgery using the natural cavity of the human body, with no incision on the body and fast postoperative recovery. Moreover, the transnasal butterfly approach can realize the bony or soft tissue saddle base reconstruction at the same time, which can effectively avoid cerebrospinal fluid leakage and intracranial infection.
Microsurgical transnasal butterfly surgery for pituitary adenoma has been very mature, but the narrow surgical field is its inherent drawback, and the exposure of tumor and surrounding important structures is limited, which not only affects the scope of tumor resection, but also increases the risk of collateral injury. With the application of neuroendoscopic techniques in transnasal butterfly surgery, the quality of pituitary adenoma surgery has been further improved, mainly in that no separation of the nasal septal mucosa is required, and the sense of smell is better preserved.