The development of transsphenoidal microsurgery and the refinement of endocrinological and radiological diagnostic procedures have afforded therapeutic options appropriate for each individual case in @entity1 with pituitary-dependent @entity699 . Compared with other secreting @entity977 , the @entity21422 seems to be the most biologically active @entity5 . Clinical evidence of @entity699 mainly occurs at an early stage of @entity5 growth when the @entity5 is very small, below the detection threshold of modern imaging techniques. While the treatment of @entity5 remains difficult due to the @entity5 and extension or invasion, surgical @entity5 requires reliable preoperative or peroperative identification in order to achieve @entity5 resection for clinical remission and pituitary preservation to prevent @entity4614 . We reviewed all the current surgical techniques or clever surgical procedures used to achieve both goals with the lowest complication rate. We report here the state-of-the-art of surgical management of corticotroph pituitary @entity652 focusing on preoperative radiological and biological data required for performing guided intrasellar surgical exploration and reliable @entity5 identification. Different technical aspects of the nasosphenoidal approaches are reported as well as the modified transdiaphragmatic or transtubercular transcisternal approaches to @entity5 in a suprasellar localization or lying along the pituitary stalk. The advantages of minimally invasive surgical techniques such as intrasellar endoscopic surgery are discussed. Adapted surgical techniques for second transnasal surgery indicated for recurrent @entity5 are described. Guidelines are given for peroperative @entity5 identification with macroscopic assessment or histological control with frozen section biopsies. Different techniques for @entity5 removal are discussed from selective microadenomectomy to enlarged pituitary resection and total hypophysectomy. Methods for preoperative guidance of @entity5 removal are proposed including histological or biological assessment of normal adjacent pituitary tissue. the strategy of surgical intrasellar exploration and @entity5 resection is outlined using a set of algorithms. The first is devoted to positive preoperative documentation of the @entity5 . The second is proposed for the surgical scenario where there is no preoperative MRI evidence of the @entity5 . Special strategies are discussed for ectopic @entity652 . Revision surgical management after surgical failure or @entity5 recurrence is described. Special guidelines for surgical treatment of large clinically silent corticotroph macroadenomas are given with emphasis on the high risk of recurrence in comparison with other silent @entity977 such as gonadotroph or immunonegative @entity652 .

[Technical aspects and surgical strategy for removal of corticotroph pituitary XXXX ].

@entity1 :: ('9606', 'Species') :: ['patients'] @entity21422 :: ('MESH:D049913', 'Disease') :: ['corticotroph adenoma'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'removal of very tiny tumors', 'total tumor', 'non-discrete boundary lines of the tumor', 'large tumors', 'tumors'] @entity699 :: ('MESH:D003480', 'Disease') :: ['hypercortisolism'] @entity4614 :: ('MESH:D007018', 'Disease') :: ['hypopituitarism'] @entity977 :: ('MESH:D010911', 'Disease') :: ['pituitary tumors'] @entity652 :: ('MESH:D000236', 'Disease') :: ['adenoma or multiple tumors', 'adenomas', 'adenoma']
@entity652 :: (MESH:D000236,Disease) :: ['adenoma']
