Transnasal transsphenoidal hypophysectomy: Choice of approach for the otolaryngologist

Increasingly, the otolaryngologist is called on to provide exposure for the neurosurgeon performing transsphenoidal hypophysectomy, The 3 most common approaches for this exposure are the transnasal transseptal, sublabial tran sseptal, and external rhinoplasty approaches. We reviewed our series of 135 patients undergoing transnasal hypophysectomy for postoperative complicati ons. In our series, we found that 18% of patients had a postoperative septa l perforation, 2% of which were symptomatic; 6% of patients reported nasal cosmetic deformity; 13% reported transient lip numbness; and 3% reported po stoperative nasal dysfunction, When comparing our complication rate with th ose published for the sublabial and external rhinoplasty approaches, we fou nd the transnasal approach provides excellent exposure with less dissection and fewer postoperative complications, On the basis of these results, we b elieve that the transnasal transseptal approach provides excellent exposure for transsphenoidal hypophysectomy in all patients who require pituitary s urgery.