Related Experiment Video
Updated: Mar 7, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
How to Expose the Entire Sella Floor With Minimal Manipulation During an Endoscopic Endonasal Transsphenoidal
Do Hyun Kim1, Yong-Kil Hong, Sin-Soo Jeun
1*Department of Otolaryngology, Head and Neck Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea †Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea ‡Department of Otolaryngology, Head and Neck Surgery, Uijeongbu St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Objective:
A method of opening the posterior ethmoid air cells with minimal manipulation is important for adequate exposure of the sella floor and minimal nasal morbidity.
Methods:
Between February 2009 and August 2016, 373 patients with skull-base tumors underwent surgery via endoscopic endonasal transsphenoidal approach with the 2-nostrils/4-hands technique using this technique.
Results:
A linear incision was made laterally toward one-third of the superior turbinate along the superior border of the sphenoid sinus ostium. Then, the superior turbinate mucosa was fully elevated to expose the superior turbinate bone. This allowed us to expose the entire sella floor and adjacent vital structures, such as the optic and carotid protuberances, medial and lateral opticocarotid recesses, planum sphenoidale, and clivus, leaving the superior turbinate and surrounding nasal mucosa intact.
Conclusion:
This technique could improve the manipulability of surgical instruments and increase the accessibility of the parasellar region. This approach better conserves the nasal mucosa, posterior ethmoid, and superior and supreme turbinates and more efficiently exposes skull-base tumors than traditional methods with pathology of the anterior cranial fossa and parasellar region. This technique also prevents the drilling procedure from damaging the surrounding nasal mucosa, including the exfoliated and laterally preserved posterior sphenoid mucosa.
