Endoscopic transsphenoidal approach through a widened nasal cavity for pituitary lesions

We operated upon 12 patients with macroadenoma and two with Rathke's cleft cyst using an endoscope through a nasal speculum. Pure endoscopic endonasal transsphenoiolal approach (TSA) was performed in nine patients and endoscope-assisted microscopic endo nasal TSA in five. A thin-bladed nasal speculum was used to achieve a wide, almost midline, pathway without an incision at the septal mucosa. This made it possible to convert from the endoscopic to the microscopic approach and vice versa at any time during operation as the occasion demanded. In 10 of the 12 patients with macroadenoma, adenomas were removed totally and did not recur during the mean follow-up period of 24 months. Two adenomas could not be removed totally due to their invasiveness. In two of five patients who underwent endoscope-assisted microscopic TSA for macroadenoma, the endoscope could visualise residual tumour at blind corners after microscopic tumor removal. Two patients with Rathke's cleft cyst did not show recurrence. No patient showed sinonasal or endocrinological complications. Versatile use of the endoscope through a widened nasal cavity using a nasal speculum is a promising tool for the treatment of pituitary lesions.