Minimally Invasive Surgery for Pituitary Adenoma

The pituitary gland is a very small-sized gland which plays an important role in regulating human well-being by controlling many activities of other hormone-secreting glands. It embeds in a midline, bony hollow of the cranial base and is surrounded by vital structures (eg: optic apparatus, cavernous sinuses, internal carotid arteries, and cranial nerves that control extraocular muscles). Adenoma of this gland is a challenging problem for neurosurgeons. Some are best managed with medication alone, but some are more responsive to surgery. Numerous refinements in surgical approaches to the pituitary gland have been proposed for decades. Advancements in modern surgical equipment and state-of-the-art technology of highly precise tools have given neurosurgeons a new, minimally invasive approach. Since the era of image-guided surgery, neurosurgeons have been offered many chances in innovating high precision surgical techniques via a very small incision or no incision at all. Patients received many benefits from the so-called minimally invasive surgery, particularly less side effects with greater patient comfort. Better outcome, little or no scarring, and lower complication rates of pituitary adenoma surgery resulted from little tissue manipulation by cutting-edge technology. However, the revolutionized pituitary surgery is still going ahead. Starting with the microscopic era, followed by image-guidance and then by endoscopic maneuver, all of these give neurosurgeons a streamlined, multidisciplinary approach in treatment of the pituitary adenoma. Another groundbreaking development in minimally invasive treatment for pituitary adenoma is robotic surgery. Robotic surgery of pituitary adenoma offers a wide range of treatment: passive, semiactive, active robots, and remote manipulators. Some of them are non-invasive alternatives to surgery such as Gamma Knife®, LINAC, Cyberknife®; they provide pain-free, non-surgical alternative treatment for surgically complex and invasive adenomas or inoperable patients. The era of robotic surgery is going to innovate pituitary glands surgery; as a technique, it is to become the gold standard treatment. Future progress will turn minimally invasive surgery into non-invasive treatment of pituitary adenoma sooner or later. This book examines all these issues and provides a prediction of what will happen in the future in the field of minimally invasive surgery, particularly for pituitary adenoma.