Staged Endoscopic Endonasal Approaches in the Management of Complex Pituitary Macroadenomas

Large pituitary macroadenomas represent difficult management problems. Traditional approaches have included a craniotomy to provide decompression of the optic apparatus in hopes of preserving vision. With the advent of endonasal endoscopy, sellar and suprasellar visualization has been dramatically improved. We postulated that intrasellar and suprasellar resection can be endoscopically performed and would provide adequate decompression of the optic apparatus. Residual tumor could be collected at a second stage resection.