Middle turbinate preservation in endoscopic transsphenoidal surgery of the anterior skull base

Endoscopic endonasal skull base surgery is a growing field in which the nasal corridors are used to address skull base lesions. Whether the middle turbinates must be removed for adequate exposure is controversial and not well addressed in the literature. This is a prospective, observational study of 163 consecutive cases of purely endoscopic endonasal transsphenoidal surgeries performed at a single tertiary care institution. The primary study outcome measurement is the feasibility of middle turbinate preservation in endoscopic transsphenoidal skull base surgery. The pathologies included 99 pituitary tumors, 15 craniopharyngiomas, 11 meningiomas, 11 Rathke's cleft cysts, 7 encephaloceles, 5 cerebrospinal fluid leak repairs, 9 clival chordomas, and 6 other pathologies of the sella. In patients undergoing surgery for a neoplasm, the average tumor size was 2.3 cm. The middle turbinate was preserved in 160/163 cases (98%). One hundred and twenty magnetic resonance imaging (MRI) studies were reviewed at a median of 16 months postoperatively and no patients (0%) developed frontal sinusitis. The middle turbinate can be preserved in nearly every endonasal, endoscopic transsphenoidal skull base case while still providing good exposure for successful tumor resection and skull base reconstruction. Postoperative sinonasal function may be better preserved with this technique.