Transsphenoidal "cross court" approach using a slightly modified speculum to reach pituitary adenomas with lateral growth

Background The purpose of this study was to evaluate the usefulness of an o blique "cross court" transsphenoidal approach using a speculum with slightl y modified projections for pituitary adenomas showing lateral extension. Method. The projection of the speculum on the side of the cavernous lesion was shortened by 5 mm. The tip of the longer projection was placed in the s phenoid sinus, while the end of the shorter projection was placed on the co ncha sphenoidalis. An oblique transsphenoidal view was then easily obtained by opening the speculum. The contralateral nasal incisura had to be widene d in some cases to achieve a more oblique view. Findings. Twenty-eight patients diagnosed with pituitary adenoma showing la teral growth underwent adenomectomy under direct observation of the medial portion of the cavernous sinus using this approach. Postoperative normaliza tion of hyperendocrinopathy or gross total removal of the tumour was achiev ed in the majority of patients. Interpretation. An oblique transsphenoidal approach using this speculum and contralateral minor maxillary osteotomy afforded a direct view of the medi al cavernous sinus, sufficient for the removal of adenomas showing minor to moderate lateral growth.