Postural Change Assists Surgical Maneuverability During Endoscopic Transsphenoidal Surgery for Pituitary Macroadenoma.

Background: In endoscopic transsphenoidal surgery for pituitary adenoma with suprasellar extension, the prolapse of the stretched floppy diaphragma sellae can obstruct the surgical corridor, posing challenges during pituitary surgery. We have introduced a simple postural change technique to mitigate this issue and are sharing our clinical experience.

Methods: Pituitary surgery is performed on an operating bed where the patient's position can be adjusted. During transsphenoidal pituitary surgery, raising the patient's head to a Fowler's position causes the diaphragma sellae to move upward, while lowering the head to a supine position causes it to descend. This simple adjustment minimizes hindrance from the floppy diaphragm sellae during surgery.

Results: We illustrate this technique in pituitary surgery, where diaphragm sellae relocation is necessary.

Conclusion: A simple postural change technique effectively manages prolapsed floppy diaphragma sellae, enhancing visualization and surgical accessibility during endoscopic transsphenoidal pituitary surgery.