ENDOSCOPIC PITUITARY SURGERY - A MINIMALLY INVASIVE TECHNIQUE

The sublabial transseptal trans-sphenoidal approach using the operatin g microscope to provide illumination and magnification is the standard approach for the majority of pituitary adenomas in most institutions. This approach combines a sublabial incision with a transfixion incisi on, and often requires removal of the anterior nasal spine and disloca tion or removal of the quadrilateral septal cartilage. We describe an endoscopic technique that is minimally invasive, requiring only a hemi transfixion incision, and preserving the anterior nasal spine. Often, it is not necessary to dislocate the septal cartilage fp om the maxill ary crest. The surgery is performed using a 4 mm 0 degree telescope. A ngled 30 degree and 70 degree telescopes are used to visualize the int rasphenoid anatomy, and may be introduced in the sellar cavity followi ng tumor removal, to ensure complete extirpation. This minimally invas ive technique has been successfully used in 80 patients with sellar le sions. The use of endoscopes offered not only the advantage of improve d visualization, but also magnification and a panoramic perspective of the important anatomical relationships of the sella turcica. It also enabled more complete tumor removal with minimally invasive techniques .