Combined Endoscopic and Microscopic Posterior Transseptal Transsphenoidal Pituitary Surgery with Neuronavigation

The aim of this presentation to establish the feasibility of combined use of endoscope and microscope for transsphenoidal sella surgery, to demonstrate the role of neuronavigation in operations and reoperations of TSS. Technical advancements such as development of navigation system have revolutionized the field of endoscopic endonasal surgery. Endoscopic and microscopic techniques are presented in the literature as alternative and competitive approaches. The authors think they are complementary and that the use of both will make surgical technique better. Prospective monocentric study. 209 patients with sellar lesions were operated in our department in the past 5 years. 36 patients with pituitary tumor were operated with the aid of an optically guided system. Total resection was achieved in all patients. Frameless stereotaxy system is accurate and obviates the need for intraoperative fluoroscopy during transsphenoidal surgery. It is useful in microadenomas, complex cases, redo cases, where the anatomical landmarks are not easy to recognizable. It makes the selected procedures easier, faster and probably safer.