Transnasal endoscopie approach to the sella turcica

The transseptal/transsphenoidal approach to the pituitary gland has been the most commonly used approach for resection of pituitary adenomas for the last 50 years. This procedure has alow morbidity and provides direct midline access to the sella and pituitary gland. Recent advancements in endoscopie surgery, however, suggest that a lower morbidity approach to the sella would be possible via transnasal endoscopie route. Prior reports have confirmed effectiveness of this approach to the pituitary gland and we report here an early series of endoscopie transnasal pituitary surgery from our institution. We report seven cases of transnasal endoscopie pituitary surgery. Our technique consists of endoscopie exposure of the sphenoid ostium unilaterally, excision of the posterior septum anterior to the rostrum of the sphenoid sinus with resection of the sphenoid rostrum for bilateral exposure of the sphenoid sinus. A specially designed nasal speculum is positioned to displace the posterior septum and lateralize the middle turbinâtes, permitting direct midline exposure of the sphenoid sinus and sella. We have progressively modified the technique over the seven cases that we present and will discuss our specific instrumentation, indications, and technique for this procedure. We have encountered one cerebrospinal fluid leak in this series. Patient satisfaction has been high and hospitalization is less than with the conventional transseptal approach, averaging 1 day. Our impression is that the transnasal endoscopie approach to pituitary adenomas is a safe technique with reduced morbidity permitting shortened hospital stay.