ENDOSCOPIC TRANSSEPTAL TRANSSPHENOIDAL SURGERY FOR PITUITARY-TUMORS

OBJECTIVE: Transseptal transsphenoidal surgery of pituitary tumors is a well-established surgical technique. The sublabial approach and the open rhinoplasty approach are most commonly used. In both cases, the s urgical avenue is along the entire length of the nasal septum, removin g both nasal cartilage and the vomer. Septal perforations and upper de ntal anesthesia are frequent complications of the standard approaches. We describe our initial experience in using the nasal endoscope for t he first stage of the operation. METHODS: A nasal endoscope was used t o open the anterior wall of the sphenoid sinus. Our initial incision w as in the posterior third of the septum, removing only the vomer. Afte r the sphenoid sinus was opened, we inserted a speculum and proceeded with the operation with an operating microscope. After the speculum wa s in place, it was easier to proceed with the microscope, which allows binocular vision and bimanual operation. RESULTS: The procedure was u sed for our most recent 14 consecutive patients with pituitary adenoma s. No complications related to the approach were encountered for any o f the patients in follow-up monitoring. CONCLUSION: The endoscopic tra nsseptal approach to the sphenoid sinus for pituitary surgery was foun d to be easy, time-saving, and without septal or sublabial complicatio ns.