Contraindications for surgery are very few, and most are relative rather than absolute. The most important contraindications relate to the general medical condition of the patient, which, in the face of florid CD, acromegaly, or secondary hyperthyroidism, can pose a significant anesthetic risk. In most cases, however, the medical condition of the patient can be stabilized without undue delay. Similarly, profound hypopituitarism can also be a temporary contraindication to surgery, although it should be fully responsive to steroid and thyroid replacement. Active
sinus infection may also contraindicate the transsphenoidal approach, although this is generally responsive to appropriate antibiotic therapy. Very rarely MRI may reveal ectatic and tortuous carotid arteries that protrude from the region of the cavernous sinus and obstruct transsphenoidal access.
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