title: Endoscopic approaches to pituitary lesions: difficulties and challenges.
abstract: OBJECTIVE
  The evolution of surgical approaches to the pituitary region brings benefits to the patient, but also means changes for otolaryngologists, who have to face new difficulties and complications. The objective of this paper was to present our experience in the endoscopic approach to the pituitary region, assessing the difficulties and complications encountered, and to offer possible elements for improvement.
  
  
  METHODS
  We reviewed the first 40 cases of pituitary approaches we carried out between 2008 and 2011. Interventions were performed by a team of neurosurgeons and otolaryngologists in simultaneous collaboration. We analysed the pathology intervened, complications and difficulties.
  
  
  RESULTS
  There were 37 patients operated on for pituitary tumours and 3 cysts; 34 cases were macroadenomas. The complications were 6 cerebrospinal fluid leaks, 3 with meningitis, 6 diabetes insipidus, 1 pulmonary embolism, 1 hydrocephalus and 4 mild nasal complications.
  
  
  CONCLUSIONS
  The frequency and type of complications depend on the extent of the endoscopic approach, patient age, tumour size and suprasellar extension. The use of specific instruments, navigation and preoperative assessment of imaging tests help to minimise complications. Prudent implementation of new approaches, knowledge of techniques and complications, and the analysis of the activity allow further progress in access to skull base pathology.
authors.affiliation: Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, España. gdlsantos@gmail.com
authors.forename: Gonzalo
authors.initials: G
authors.lastname: de los Santos
authors.forename: Claudio
authors.initials: C
authors.lastname: Fragola
authors.forename: Raúl
authors.initials: R
authors.lastname: Del Castillo
authors.forename: Víctor
authors.initials: V
authors.lastname: Rodríguez
authors.forename: Claudio
authors.initials: C
authors.lastname: D'oleo
authors.forename: Pablo
authors.initials: P
authors.lastname: Reyes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010900:Pituitary Diseases / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies
keywords: Base de cráneo; Cerebrospinal fluid rhinorrhoea; Fístula de líquido cefalorraquídeo; Hipófisis; Meningitis; Nasal surgical procedures; Neoplasms; Pituitary gland; Procedimientos quirúrgicos nasales; Skull base; Tumor