Endoscopic-guided direct endonasal approach for pituitary surgery

Area of Science:

• Neurosurgery
• Endoscopic Skull Base Surgery
• Otolaryngology

Background:

• Transseptal approach to the sella often includes submucosal dissection of the nasal septum.
• The necessity of this dissection in pituitary surgery requires evaluation.
• Comparison of morbidity between direct transmucosal endonasal and transseptal approaches is needed.

Purpose of the Study:

• To compare the morbidity of a direct transmucosal endonasal approach versus the transseptal approach for pituitary surgery.
• To evaluate the impact of eliminating submucosal nasal septum dissection on patient outcomes.

Main Methods:

• A comparative study of 41 consecutive patients undergoing pituitary surgery (January 1996 - March 1999).
• Group 1 (n=21): Standard transseptal operation (sublabial or columellar incision).
• Group 2 (n=20): Endoscopically guided, direct endonasal exposure without septal dissection.
• Comparison of operative morbidity, surgery duration, and hospitalization length.

Main Results:

• Endonasal route provided comparable sphenoid sinus exposure adequate for most pituitary tumor resections.
• Operative morbidity was similar between the two groups.
• Endonasal approach resulted in significantly less postoperative facial pain, shorter operation times (116 vs. 161 minutes), and reduced hospitalization (3.6 vs. 5.1 days).

Conclusions:

• The endonasal approach to the sphenoid sinus demonstrates comparable morbidity to the conventional transseptal approach.
• Eliminating submucosal dissection via the endonasal route significantly reduces postoperative facial discomfort.
• The endonasal approach leads to decreased surgery duration and shorter hospital stays.