• John S Kuo, Garni Barkhoudarian, Christopher J Farrell, Mary E Bodach, Luis M Tumialan, Nelson M Oyesiku, Zachary Litvack, Gabriel Zada, Chirag G Patil, and Manish K Aghi.
• ‡Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin; §Brain Tumor Center and Pituitary Disorders Program, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California; ¶Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania; ‖Guidelines Department, Congress of Neurological Surgeons, Schaumburg, Illinois; #Barrow Neurological Institute, Phoenix, Arizona; **Department of Neurosurgery, Emory University, Atlanta, Georgia; ‡‡Department of Neurosurgery, George Washington University, Washington, DC; §§Department of Neurological Surgery, University of Southern California, Los Angeles, California; ¶¶Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; ‖‖Department of Neurosurgery, University of California, San Francisco, San Francisco, California.
• Neurosurgery. 2016 Oct 1; 79 (4): E536-8.

BackgroundNumerous technological adjuncts are used during transsphenoidal surgery for nonfunctioning pituitary adenomas (NFPAs), including endoscopy, neuronavigation, intraoperative magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) diversion, and dural closure techniques.ObjectiveTo generate evidence-based guidelines for the use of NFPA surgical techniques and technologies.MethodsAn extensive literature search spanning January 1, 1966, to October 1, 2014, was performed, and only articles pertaining to technological adjuncts for NFPA resection were included. The clinical assessment evidence-based classification was used to ascertain the class of evidence.ResultsFifty-six studies met the inclusion criteria, and evidence-based guidelines were formulated on the use of endoscopy, neuronavigation, intraoperative MRI, CSF diversion, and dural closure techniques.ConclusionBoth endoscopic and microscopic transsphenoidal approaches are recommended for symptom relief in patients with NFPAs, with the extent of tumor resection improved by adequate bony exposure and endoscopic visualization. In select cases, combined transcranial and transsphenoidal approaches are recommended. Although intraoperative MRI can improve gross total resection, its use is associated with an increased false-positive rate and is thus not recommended. There is insufficient evidence to recommend the use of neuronavigation, CSF diversion, intrathecal injection, or specific dural closure techniques. The full guidelines document for this chapter can be located at https://www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas/Chapter_6.AbbreviationsCSF, cerebrospinal fluidNFPA, nonfunctioning pituitary adenoma.

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