Abstract
Although the recent progress in neruoendoscopy including image-guidance techniques has enhanced pituitary surgery via the transsphenoidal route, it still requires the surgeon possess sophisticated skills to overcome conflicts between the lens rod-scope and surgical tools in the narrow surgical corridor. To achieve a safe and reliable technique, a systematic understanding of the anatomical structures of the nasal cavity, sphenoid and ethmoid sinuses, and sellar region are mandatory. The nasal phase is the first step of the procedure, which includes the inferior and middle turbinates, bony septum of the vomer, perpendicular plate of the ethmoid bone and sphenopalatine artery as important landmarks. For the sphenoid phase, the superior turbinate, posterior ethmoid sinus, sphenoid septum, optic prominence, carotid prominence, and opticocarotid recess should be cared for before approaching the sellar floor. Finally, after making an incision into the sellar floor dura matter and medial cavernous sinus wall, such structures as diaphragm sellae, and arachnoid recess should be mentioned. In this article, the authors describe the basis of microsurgical anatomy in a step-by-step way in relation to pure endoscopic endonasal removal of pituitary tumors.
