Historically, pituitary tumours have been surgically managed with an open, transcranial approach. Although this approach still has its merits in large intracranial adenomas, technological advancement has allowed smaller tumours to be debulked via a transseptal microscopic technique. These days, the endoscopic endonasal transsphenoidal approach is increasingly recognised as an equal parallel to the microscopic technique, with arguably more favourable intraoperative visualisation. The expertise of the ENT surgeon, with our greater understanding of the nasal anatomy, allows us to work with neurosurgeons to define the right indication for each pituitary tumour surgery and weigh in on each aspect of the multidisciplinary management. This review reaffirms that the endoscopic approach provides reasonable rates, favourable clinical outcomes and acceptably low complication rates. The commonest ENT-related complications include cerebrospinal fluid leak, sinusitis, epistaxis, and nasal septal perforation. 

Endoscopic endonasal extended approaches for the management of large pituitary adenomas.
Cappabianca P, Cavallo LM, de Divitiis O, de Angelis M, Chiaramonte C, Solari D.
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Gentle Wong

Guy's and St Thomas' Hospitals, UK.

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