title: Observation of the neurohypophysis, pituitary stalk, and adenohypophysis during endoscopic pituitary surgery: demonstrative findings as clues to pituitary-conserving surgery.
abstract: BACKGROUND
  High-definition imaging in endoscopic transsphenoidal pituitary surgery accounts for significantly better identification of anatomic structures. This report presents the clinical images of the adenohypophysis and neurohypophysis under high-definition endoscopic observation, and provides some clues for pituitary-sparing surgery.
  
  
  METHODS
  Ten demonstrative cases of pituitary lesions, including three cases of gonadotropin-producing pituitary adenoma, two cases of somatotropin-secreting pituitary adenoma, and five cases of Rathke's cleft cysts, were entered in this study. From these cases, we extracted helpful intraoperative findings that affected the surgeon's decision about surgical procedures and led to favorable results.
  
  
  RESULTS
  The extracted findings contain the following lessons: (1) to find a boundary plane that separate a lesion from the pituitary; (2) to mark the difference of color between the adenohypophysis and the neurohypophysis; (3) to identify the location of the pituitary stalk connecting to the neurohypophysis; (4) to observe the color change of the pituitary induced by decompression; (5) to know pathological findings of the pituitary surface; (6) to distinguish the parenchyma of the neurohypophysis from pathological tissues; and (7) to recognize the intrasellar findings at the completion of removal. Recognition of these findings led to an excellent result in each case.
  
  
  CONCLUSIONS
  Despite being shown in a limited number of cases, on the basis of HD endoscopic images, accurate identification of the neurohypophysis and the pituitary stalk as well as adenohypophysis during surgery contributes to pituitary-conserving operations.
authors.affiliation: Department of Neurosurgery, Brain Research Institute, University of Niigata, 1-757 Asahimachi-dori Chuo-ku, Niigata, 951-8585, Japan. yone@bri.niigata-u.ac.jp
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yoneoka
authors.forename: Naoto
authors.initials: N
authors.lastname: Watanabe
authors.forename: Masayasu
authors.initials: M
authors.lastname: Okada
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Fujii
mesh_terms: D000328:Adult; D003952:Diagnostic Imaging; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000473:pathology / Q000601:surgery*; D010903:Pituitary Gland, Anterior / Q000473:pathology / Q000601:surgery*; D010904:Pituitary Gland, Posterior / Q000473:pathology / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*