The transseptal transsphenoidal approach allows the surgeon to reach lesions located in the middle of the skull base and is widely accepted as the procedure of choice for the surgical treatment of pituitary adenomas with a primary sellar extension. Despite variations, the procedure consists of a few, well-defined, critical steps. The procedure is not only effective but also is well tolerated by patients who can be discharged home 2 or 3 days after surgery with no externally visible scar.
The transsphenoidal procedure as used today was described and successfully performed almost a century ago. This approach is now widely accepted and considered the procedure of choice for most patients with pituitary tumors. Many subsequent refinements and descriptions have been published.[3,9] This article summarizes and illustrates the critical steps for performing a successful transsphenoidal procedure.