الفهرس 
Historical BackgroundOnly 14 pages are availabe for public view
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Abstract
The evolution of pituitary surgery during the last century was characterized by the development of progressively less invasive approaches to the pituitary gland that have been facilitated by simultaneous advances in medical technology.52 The tendency to be as minimally invasive as possible with a minimum of iatrogenic traumatization and to achieve a maximum of efficiency in the treatment of a patient has existed since the beginning of surgery. The development of unconventional or ”difficult approaches”, which is based on increased knowledge of microsurgical anatomy, improved preoperative diagnostic techniques, and well-adapted microsurgical instruments, definitely forms one important aspect of ”refinement in microneurosurgical operating”.
In the last 10 years the assisted endoscopic endonasal transsphenoidal approach has been proposed as a minimally invasive procedure for the treatment of pathologies of the sellar region. The refinement of minimally invasive endoscopic techniques has resulted in ’pure’ endoscopic endonasal trans-sphenoidal surgery for the removal of pituitary tumors. This procedure is performed via a wide anterior sphenoidotomy with detachment of the septum from the sphenoid face, and avoids the use of a transsphenoidal retractor and any intraoral or nasal incisions. Straight and angled endoscopes are used throughout the procedure to provide a wide view of the sella and are manipulated by a co-surgeon.
For the most of pituitary adenoma; surgery is done by a transsphenoidal approach, while some of them are still done by a craniotomy, according to the tumor size, locations and symptoms. Many different approaches for treating lesions in the anterior fossa or sellar region have been described. Improvements in microsurgical techniques and instruments have made keyhole exposure for cerebral surgery possible. The effects of keyhole surgery are less traumatic, preserving cerebral integrity as much as possible, while limiting brain exposure. The supraorbital approach is a typical approach for keyhole surgery applied to anterior cranial fossa lesions.
Utilizing small eyebrow incisions, a small supraorbital keyhole craniotomy, and microneurosurgical access, allows gaining excellent optimal and safe exposure to a number of different pathologies of the anterior base and parasellar regions. The lesions can be resected under complete control and with full preservation of surrounding neurovascular structures.
In an attempt to explore these two new minimally invasive approaches, this study was designed to evaluate the outcome, safety, efficacy and complications of minimally invasive supraorbital craniotomy and endoscopic transsphenoidal approaches in treatment of pituitary Macroadenoma.
Our study included 35 patients, with pituitary macroadenomas who underwent complete preoperative clinical assessment and thorough endocrinological and radiological evaluation. The patients were up postoperatively followed up clinically, endocrinologicaly and radiologically.
Analyzing our results and comparing them to the published clinical studies in the neurosurgical literatures, we concluded that the endoscopic transsphenoidal approach and the supraorbital approach for management of pituitary lesions are as safe and as efficient as the conventional microscopic transsphenoidal and transcranial approaches respectively, with less morbidity and complications.
It is our recomedation that these two approaches are to be considered as the standard treatment for management of patients with pituitary macroadenoma.