Modified transseptal approach in endoscopic transsphenoidal pituitary surgery

Area of Science:

• Neurosurgery
• Otolaryngology
• Endoscopic Sinus Surgery

Background:

• Transsphenoidal pituitary surgery is frequently performed using a direct transostial approach necessitating a posterior septectomy.
• An alternative endoscopic transseptal route exists but presents its own set of disadvantages.

Purpose of the Study:

• To describe a modified endoscopic transseptal technique for pituitary surgery.
• To discuss the advantages and disadvantages of this modified approach.

Main Methods:

• The technique involves an initial mucosal incision at the anterior middle turbinate level.
• A mucoperichondrial flap is raised ipsilaterally to the sphenoid sinus ostium.
• An incision at the osseocartilaginous junction allows for contralateral flap raising, with excision of the bony septum and posterior flap aspect.
• The size and position of the surgical window are adaptable, and the flap is repositioned to the midline post-operatively.

Main Results:

• The modified approach avoids the need for excising or deflecting the cartilaginous septum.
• It successfully maintains an intact mucoperichondrial flap on one side of the septum.
• This method prevents the occurrence of a septal perforation.

Conclusions:

• The described modification offers a viable alternative to traditional transsphenoidal surgical techniques.
• It preserves septal integrity, potentially reducing complications associated with septal resection.
• This approach may enhance patient recovery and surgical outcomes in pituitary surgery.