Hostname: page-component-6bf8c574d5-qdpjg Total loading time: 0 Render date: 2025-02-16T22:50:33.667Z Has data issue: false hasContentIssue false
  • English
  • Français

Modified transseptal approach in endoscopic transsphenoidal pituitary surgery

Published online by Cambridge University Press:  17 February 2023

R Gan Open the ORCID record for R Gan [Opens in a new window] ,
S Stokes ,
A Bahl  and
J Jose
R Gan*
Affiliation:
Ear, Nose & Throat Department, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
S Stokes
Affiliation:
Neurosurgery Department, Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, UK
A Bahl
Affiliation:
Neurosurgery Department, Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, UK
J Jose
Affiliation:
Ear, Nose & Throat Department, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
*
Author for correspondence: Mr Richard Gan, ENT Department, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Castle Road, Cottingham HU16 5JQ, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Transsphenoidal pituitary surgery is commonly performed via a direct transostial approach with a posterior septectomy. However, a technique via an endoscopic transseptal route has been described that avoids a posterior septectomy, but it comes with its own disadvantages.

Methods

This paper describes a modification, and discusses its pros and cons.

Results

The initial incision in the mucosa is placed level with the anterior middle turbinate. The mucoperichondrial flap is raised ipsilaterally until the sphenoid sinus ostium. An incision is made at the osseocartilaginous junction, and the contralateral mucoperichondrial flap is raised. The bony septum and posterior aspect of this flap is excised. The size and position of this window can be adapted. At the end of the operation, the lateralised intact mucoperichondrial flap is moved back to the midline.

Conclusion

Excision or deflection of the cartilaginous septum is not required. It maintains an intact septal mucosa on one side and avoids a septal perforation.

Keywords

Pituitary NeoplasmEndoscopic Surgical ProceduresPituitary Adenoma
Type
Short Communications
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 12 , December 2023 , pp. 1409 - 1412
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Mr R Gan takes responsibility for the integrity of the content of the paper

References

Patel, SK, Husain, Q, Eloy, JA, Couldwell, WT, Liu, JK. Norman Dott, Gerard Guiot, and Jules Hardy: key players in the resurrection and preservation of transsphenoidal surgery. Neurosurg Focus 2012;33:E610.3171/2012.6.FOCUS12125CrossRefGoogle Scholar
Jankowski, R, Auque, J, Simon, C, Marchal, JC, Hepner, H, Wayoff, M. How I do it: head and neck and plastic surgery: endoscopic pituitary tumor surgery. Laryngoscope 1992;102:198–20210.1288/00005537-199202000-00016CrossRefGoogle Scholar
Papay, FA, Stein, JM, Rhoten, RL, Luciano, M, Zins, J, Hahn, J. Transnasal transseptal endoscopic approach to the sphenoid sinus. J Craniofac Surg 1997;8:159–6310.1097/00001665-199705000-00003CrossRefGoogle Scholar
Favier, V, Boetto, J, Cartier, C, Segnarbieux, F, Crampette, L. Endoscopic transnasal transseptal pituitary surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2019;136:131–410.1016/j.anorl.2018.10.005CrossRefGoogle ScholarPubMed
Gomez, GM, Yanez-Siller, JC, Carrau, RL, Montaser, A, Lima, LR, Servian, D et al. Endonasal anatomy of the olfactory neural network: surgical implications. Laryngoscope 2018;128:2473–710.1002/lary.27194CrossRefGoogle Scholar