Review Recent developments in transsphenoidal surgery of pituitary tumors

est procedures in contemporary neurosurgical prac-tice. However, complications can occur during or af-ter this procedure, some of which can be associated with significant morbidity and, rarely, also with mor-tality1. Thus, there are still areas in need of improve-ment2. As might be expected, neurosurgeons have tried to develop strategies and new technical tools to im-prove the surgical outcome. As a result, a variety of important innovations have been introduced during recent years. Among these, the most important and effective have been the use of the endoscope for trans-sphenoidal surgery, the application of neuronaviga-tion techniques in these skull base procedures and intraoperative imaging, particularly resection control of large tumors by magnetic resonance imaging car-ried out during the operative procedure. While some advances are conceptual and others are technical, all are helping to push the limits of pi-tuitary surgery to new frontiers of efficiency and safe-ty. In this paper, the current state of possibilities and limitations of the newly introduced techniques is re-viewed with a strong personal bias resulting from the experience of the authors with these techniques. De-spite all the technical advances, a proper preopera-tive workup of the patients, including a complete set of endocrinological, radiological and ophthalmologi-cal investigations, an interdisciplinary treatment plan and a precise knowledge of the respective anatomy and the surgeons experience with the procedure, re-main the fundamentals of a successful surgical pra-ctice in this area and the basis of satisfaction of the endocrinologist3