Total septal preservation for sellar approach - paving the way for future flap reconstructions

Despite being a single surgical channel this approach provides enough room and maneuverability for microscopic and endoscopic surgery of sellar lesions and the total septal preservation technique allows future reconstructions using the posterior nasoseptal flap.

To demonstrate the importance and feasibility of total nasal septum and anterior sphenoid preservation in transseptal approaches to the sella.

Retrospective evaluation of 15 transseptal approaches for sellar lesions with or without suprasellar extensions operated under general anesthesia with a total septal preservation technique.

In all patients operated by this method a complete microscopic and endoscopic tumor removal was possible and an uneventful recovery was observed. Nasal congestion was mild and no episode of nasal bleeding, cerebrospinal leaks, visual loss, diabetes insipidus or death was observed. Breathing was considered normal or improved in all patients after removal of splints; this subjective sensation was confirmed at 1 month and 6 months follow-up visits. No external nose deformities or septal deviations were observed; nasal endoscopy demonstrated a preserved septum and anterior sphenoid wall anatomy on both sides of the nose at 1 month and 6 months follow-up visits. CT scans taken at 6 months after the procedure confirmed these clinical findings.