TRANSNASAL ENDOSCOPIC APPROACH TO THE SELLA TURCICA

The transseptal/transsphenoidal approach to the pituitary gland has be en the most commonly used approach for resection of pituitary adenomas for the last 50 years. This procedure has a low morbidity and provide s direct midline access to the sella and pituitary gland. Recent advan cements in endoscopic surgery, however, suggest that a lower morbidity approach to the sella would be possible via transnasal endoscopic rou te. Pries reports have confirmed effectiveness of this approach to the pituitary gland and we report here an early series of endoscopic tran snasal pituitary surgery from our institution. We report seven cases o f transnasal endoscopic pituitary surgery. Our technique consists of e ndoscopic exposure of the sphenoid ostium unilaterally excision of the posterior septum anterior to the rostrum of the sphenoid sinus with r esection of the sphenoid rostrum for bilateral exposure of the sphenoi d sinus. A specially designed nasal speculum is positioned to displace the posterior septum and lateralize the middle turbinates, permitting direct midline exposure of the sphenoid sinus and sella. We have prog ressively modified the technique over the seven cases that we present and will discuss our specific instrumentation indications, and techniq ue for this procedure. We have encountered one cerebrospinal fluid lea k in this series. Patient satisfaction has been high and hospitalizati on is less than with the conventional transseptal approach, averaging 1 day. Our impression is that the transnasal endoscopic approach to pi tuitary adenomas is a safe technique with reduced morbidity permitting shortened hospital stay.