A minimally invasive endoscopic transsphenoidal approach with an endonasal septal pushover technique by using a...

Whereas the endoscopic endonasal transsphenoidal approach has been applied in patients with pituitary lesions as a potentially efficacious and less invasive surgical technique, the sinonasal step of a series of the surgical procedures is generally not well known to neurosurgeons. This is one of the reasons why the endoscopic technique has not been fully been adopted as a routine surgical procedure approaching towards the sella. The present paper describes the technical details of a purely endoscopic approach using an endonasal septal pushover technique. We also present a newly designed nasal speculum specialized for this endoscopic endonasal technique. As compared to the endoscopic endonasal approach previously reported, the surgical procedure required for sphenoidotomy with the aid of the modified speculum was simplified and thereby less time-consuming. This technique has been performed in 40 patients with several types of pituitary lesions. All patients recovered rapidly without significant rhinological complications. Despite a limited number of cases, our experience suggests that this simplified endoscopic technique could encourage a more routine use of endoscopes in the endonasal approach for pituitary lesions.