Risks of transsphenoidal surgery

The sellar and parasellar area is the site of many pituitary-related tumors and cysts including the most common pathologies pituitary adenomas, Rathke’s cleft cysts, and craniopharyngiomas. For the great majority of these lesions, when symptomatic, surgery is considered first-line therapy. The transsphenoidal approach has evolved considerably and is considered the preferred route for most pathologies. However, despite accumulating worldwide experience and technological advances, including increasing use of an endoscopic approach, complications and suboptimal outcomes can and do occur. This chapter discusses the risks of surgery and strategies as well as clinical protocols from the preoperative to the postoperative phase to avoid complications and optimize outcomes while stressing the importance of teamwork in managing these complex patients.