In transsphenoidal hypophysectomy, the patient is given general anesthesia, after which the physician makes an incision in the superior gingival tissue of the maxilla. After dissecting membranes and tissues, he places a speculum blade in the developed space slightly anterior to the sphenoid sinus to avoid lateral compression of the opened anterior walls of the sinus. (Some physicians prefer the septal passage approach for the speculum.) Then he evaluates the deeper anatomy using an operating microscope with binocular vision and high–power lighting.

Using a microdrill, the physician penetrates the sphenoid bone to visualize the anterior sella floor. He can then resect and aspirate a soft tumor downward. Before wound closure, he may apply hemostatic agents such as oxidized cellulose cotton. Alternatively, he may use the patient’s own subcutaneous fat or a muscle plug from the thigh as intrasellar graft tissue. The sella floor may be sealed off with a small piece of bone or cartilage.

Finally, the physician inserts nasal catheters with petroleum gauze packed around them. He closes the initial incision with stitches inside the inner lip.

Transient diabetes insipidus is a common postoperative problem; in some cases, it’s followed by transient syndrome of inappropriate antidiuretic hormone, which necessitates careful patient monitoring for 24 to 48 hours. Other potential complications include infection, cerebrospinal fluid (CSF) leakage, hemorrhage, and visual defects. Total pituitary gland removal causes a hormonal deficiency that calls for close monitoring and replacement therapy; usually, though, the anterior pituitary is preserved.