A highly skilled neurosurgical team is directed by Sandeep Kunwar, MD, specializing in transsphenoidal surgery for pituitary adenomas and parasellar lesions. The objective of the surgical team is always to optimize cure and preserve gland function.

Transsphenoidal Surgery

In 2000, the direct endonasal approach for transsphenoidal surgery was developed at UCSF making this surgery even less invasive and greatly reducing surgical complications. More of these operations have been performed at UCSF than any other site in the United States.

Advantages to the endonasal transsphenoidal operation:

• No intranasal or sublabial incisions
• No nasal packing
• Improved visualization and illumination with the use of an endoscope
• 85% of patients return home the day after surgery, regardless of tumor size
• Complete removal of tumors as large as 5 cm
• Large experience minimizes risk of recurrence or need for postoperative radiotherapy
• Tumor is removed with preservation of the normal gland
• Minimal blood loss
• Low complication rates (0% mortality in over 1000 operations, <1% major morbidity)
• New techniques to eliminate CSF leaks

Left: Coronal post contrast-enhanced T1-weighted MR image shows a large enhancing pituitary macroadenoma displacing the optic chiasm and deforming the floor of the sella. Right: Three-month post-transsphenoidal resection of adenoma shows no residual disease and normal optic nerves.

Extended Transsphenoidal Surgery

Extended transsphenoidal surgery extends into the brain cavity without requiring a craniotomy and is used to treat tumors that can not be reached by the standard method, including meningiomas, chordomas, and chondrosarcomas, as well as clival tumors, craniopharyngiomas, and tumors of the hypothalamus or optic nerves.

Craniotomy

Craniotomy for pituitary adenomas is very rare, but minimally invasive keyhole craniotomy is a treatment option, if necessary. Even large pituitary adenomas can now be approached by the extended transsphenoidal approach.

FAQ about surgery for pituitary adenomas

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