Navigating Challenges in the Resection of Sella Turcica Tumors: A Review of Surgical Techniques

• DOI: https://doi.org/10.22533/at.ed.1594432407059

• Palavras-chave: Sella Turcica; Pituitary Adenoma; Surgery Approaches; Neuroendocrinology.

• Keywords: Sella Turcica; Pituitary Adenoma; Surgery Approaches; Neuroendocrinology.

• Abstract: INTRODUCTION: The sella turcica, a critical anatomical depression in the sphenoid bone, houses the pituitary gland and is closely associated with vital neurovascular structures, posing significant challenges for surgical interventions on tumors in this region. Diagnostic imaging, particularly MRI, is pivotal for delineating tumors and planning surgery, while the necessity of biopsy prior to curative intervention depends on the suspected tumor type, with pituitary adenomas often not requiring biopsy but non-pituitary tumors generally needing histological confirmation to guide treatment strategies. OBJETIVE: Analyze and describe the main aspects of Surgical Techniques in the Resection of Sella Turcica Tumors in the last years. METHODS: This narrative review used as descriptors “Neurosurgical Procedures,” “Diagnostic Imaging Techniques,” “Endoscopic Surgical Techniques,” “Pituitary Neoplasms,” and “Neuroendocrinology” included studies in the MEDLINE – PubMed (National Library of Medicine, National Institutes of Health), COCHRANE, EMBASE and Google Scholar databases. RESULTS AND DISCUSSION: The surgical management of tumors in the sella turcica has evolved significantly, predominantly favoring minimally invasive transsphenoidal approaches due to their efficacy and safety. These methods, especially when utilizing endoscopic techniques, offer superior visualization and reduced morbidity compared to traditional approaches like the transcranial route. Technological advancements, such as intraoperative imaging and robotic surgery, although limited by cost and training requirements, further enhance surgical precision and outcomes. The importance of an interdisciplinary approach involving neurosurgeons, endocrinologists, and radiologists is emphasized to optimize patient outcomes. Future directions point towards personalized surgical interventions and the integration of emerging technologies like artificial intelligence to predict outcomes and improve surgical planning, aiming for maximal tumor resection with minimal complications. CONCLUSION: The review of surgical approaches for tumors in the sella turcica underscores the advantages of minimally invasive endoscopic transsphenoidal methods, which optimize recovery and reduce morbidity. Future advancements in technology and interdisciplinary collaboration are anticipated to further refine these surgical techniques, enhancing precision and patient-specific outcomes.