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aHave been excluded: 5 cases of CSF leak, 2 cases of sphenoid mucocele, and 1 case of residual nasal meningocele.

Have been excluded: 5 cases of CSF leak, 2 cases of sphenoid mucocele, 1 case of olfactory neuroblastoma, 1 case of sphenoid metastasis, and 1 case of residual nasal meningocele.

aHave been excluded: 5 cases of CSF leak, 2 cases of sphenoid mucocele, and 1 case of residual nasal meningocele.

Have been excluded: 5 cases of CSF leak, 2 cases of sphenoid mucocele, 1 case of olfactory neuroblastoma, 1 case of sphenoid metastasis, and 1 case of residual nasal meningocele.

• There is no fixed tunnel, and the surgeon can, therefore, make significantly wider movements with the instruments, especially laterally.

• There is no postoperative facial swelling or nasal pain caused by spreading of the blades of the nasal speculum.

• Nasal packing is not used because the procedure is endonasal and there is no need to approximate the dissected septal mucosa to the septal cartilage at the end of the procedure. As a consequence, postoperative breathing difficulties are avoided.

• The recovery is quick, often with a single postoperative overnight stay, especially in nonfunctioning macroadenomas.

The other advantages arise from the use of the endoscope itself:

• The endoscope, like the microscope, is still simply a surgical tool for seeing but, unlike it, offers a wider surgical field, even with the 0° lens, a field that can be further enlarged by using angled lenses (30°, 45°). Being able to work in a wider surgical field is safer and, moreover, the angled-lens endoscope enables the surgeon to operate on tumors in the suprasellar region under direct visual control.

• The endoscope magnifies a part of the central surgical field. This close-up view helps contrast the tumor from the surrounding structures, permitting a much clearer and safer removal of the lesion.

Surgical indications for endoscopic pituitary surgery are the same as those for conventional microscopic transsphenoidal procedures. An added bonus is that the treatment of recurrences is easier (16). Often, a second conventional operation is more difficult and has more risks. The distorted anatomy, adhesions, scars, and septal perforation may lead to the loss of the midline and potential injury to structures in and around the sella. With the endoscopic procedure, avoiding the submucosal nasal phase of the conventional operation, the real beginning of the operation is in the sphenoid sinus. The endoscope provides better anatomic orientation in the nasal cavity, and in the sphenoid sinus the panoramic view permits the distinction of the borders of the previous approach from the surrounding structures.

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