Pituitary Gland Surgical Emergencies The Role of Endoscopic Intervention

In the era of modern pituitary gland surgery, true surgical emergencies are rare.1-3 These challenging events can occur throughout the perioperative period and are broadly categorized by the timing of occurrence. Acute indications for pituitary surgery include pituitary apoplexy, vision loss, and severe Cushing presentation. Emergencies can also occur intraoperatively, primarily secondary to bleeding. Postoperative emergencies include epistaxis, pneumocephalus, and intracranial bleeding (Box 1). Cerebrospinal fluid (CSF) leak occurs in up to 37.4% of transsphenoidal sellar surgery, yet postoperative CSF leaks are less frequent at approximately 2.6%.4 As they occur often during pituitary surgery, CSF leaks alone are generally not considered a true surgical emergency unless associated with symptomatic tension pneumocephalus. Complications leading to a surgical emergency can occur with both endoscopic and microscopic approaches; however, there is evidence to suggest the complication rate may be lower with endoscopic techniques.5,6 Furthermore, use of the endoscope is poised to manage many of the complications of pituitary gland surgery, as it offers