Anaesthesia for pituitary surgery

Surgical lesions of the pituitary gland, the majority of which are benign adenomas of the anterior lobe, present a varied and challenging spectrum of peri-operative anaesthetic problems. Successful management is based on a comprehensive understanding of the applied anatomy and physiology of the pituitary gland, the endocrine and neurosurgical consequences of pituitary adenomas and the specific implications of the chosen neurosurgical approach. The majority of pituitary adenomas can be resected adequately by an extracranial trans-sphenoidal approach, although transcranial resection may be necessary if the tumour has a significant suprasellar extension or if the diagnosis is in doubt. In general terms, pituitary surgery demands the same levels of peri-operative care as those required by intracranial surgery.