Complication Avoidance and Management Techniques

 | Post date: 2018/07/31 | 

Book Review: Transsphenoidal Surgery: Complication Avoidance and Management Techniques

Deeper understanding and mastery of the techniques of transsphenoidal surgery is now essential for any practicing cranial neurosurgeon. As technology advances and our experience with this technique improve, many more surgical procedures for tumors in the skull base are best performed using this approach. The days when transsphenoidal surgery was limited to treatment of pituitary tumors is past, and therefore there is a need for comprehensive sources of information regarding all aspects of this surgical approach.

Advancements in the field have resulted from improved preoperative and intraoperative radiological imaging, enhanced microsurgical and endoscopic technology, refinements and delivery of focused radiosurgery via a variety of instruments, as well as a much more detailed and comprehensive understanding of tumor biology. The development of medical approaches based on an explosion of scientific knowledge regarding the molecular basis of tumor growth has also improved exponentially. All of this information is essential to understand before undertaking skull base surgery, and results from collegial interdisciplinary efforts. Today's cranial neurosurgeon has an obligation to understand these aspects of tumor biology and treatment in order to optimize his or her own delivery of patient care.

The anatomic complexities of the sellar and parasellar area as well as the entire skull base makes these areas one of the most challenging regions for delivering precise surgical intervention. As even the best devised surgical plans can fail, the successful surgeon needs to possess a detailed and comprehensive understanding of anatomy, surgical approaches, as well as complication recognition and avoidance.

This book edited by Drs Laws, Cohen-Gadol, Schwartz, and Sheehan provides a wealth of information regarding clinical knowledge and multidisciplinary approaches for management of patients harboring tumors that are suitable for this surgical approach. A number of chapters focus on surgical techniques, and emphasis is placed not only on the advantages or disadvantages of a particular approach, but also on methods to be utilized to avoid complications.

The book covers topics that range from the history of pituitary surgery and the transsphenoidal approach to quality of life assessments that are so important for patients. Chapters focus on preoperative assessment and planning, various intraoperative techniques, postoperative management, and adjuvant therapy for patients with recurrent or residual disease. A large number of chapters contain precise and detailed illustrations that leave the reader step-by-step through the various approaches that the authors are describing, and these are invaluable. Online videos associated with purchase of the book further enhance one's ability to study these techniques in detail. The diversity of topics in the book also underscores the multidisciplinary team approach that is essential for management of patient's with these conditions.


Every chapter is written by a well-known and established expert in the field. Many of these contributors share “pearls” of wisdom that has been gained over many decades of clinical experience. Variations in technique from one expert to another exist, and the astute reader has an opportunity to evaluate each aspect of these various techniques and decide which will be best to utilize in different clinical situations.

Like any book, some chapters are better than others and contain more detailed diagrams and illustrations. Chapters regarding the surgical anatomy of the sellar region, combined hybrid microscopic and endoscopic transsphenoidal surgery, transcranial approaches to the sellar and parasellar areas, and the role of endoscopic transsphenoidal surgery in the management of complex lesions involving the skull base are particularly helpful because of extensive diagrams and illustrations that very accurately and precisely demonstrate the anatomy and the step-by-step details of the various surgical approaches. Other chapters regarding medical management of pituitary adenoma patients, transsphenoidal surgery for recurrent disease, and surgical treatment of craniopharyngiomas are also very useful and provide new and important information.

Chapters discussing detailed information and outcome data for patients with prolactinomas, growth hormone tumors, and Cushing's disease provide new data regarding the outcome of surgical intervention. Chapters discussing pituitary apoplexy and the treatment of pituitary tumors in pediatric patients, as well as the approach giant adenomas are also very useful. Information regarding stereotactic radiosurgery and operative indications and pitfalls also are useful. The chapter on the neuro-ophthalmology of patients with these conditions is particularly detailed and useful for surgeons who treat patients with disorders in the visual system. The online extras in the form of video demonstrations represent hundreds of hours of work by the various authors, and are a wonderful enhancement for those who purchase the book.

The book is a useful addition to the library of all surgeons who deal with skull base cranial surgery, and provides outstanding information and reference sources for complex skull base procedures amenable to the transsphenoidal approach. As technology advances and outcomes using this technique continue to be superior, more cranial surgeons should familiarize themselves with this technique.

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