Sublabial rhinoseptoplastic technique for transsphenoidal pituitary surgery by a hinged-septum method. Technical note

Area of Science:

• Neurosurgery
• Otorhinolaryngology
• Endocrinology

Background:

• The transseptal, transsphenoidal approach is a common surgical route to the sella turcica.
• Existing techniques may involve risks of septal complications.
• Improved surgical methods are needed for better exposure and preservation of nasal structures.

Purpose of the Study:

• To describe a new modification of the transseptal, transsphenoidal approach.
• To evaluate the efficacy and safety of this modified technique.
• To present surgical instrument modifications.

Main Methods:

• Unilateral dissection of septal mucosa via a sublabial route.
• Retraction of the nasal septum using an L-shaped osteotomy at the septal base and anterior sphenoid wall.
• En bloc resection of the anterior sphenoid sinus wall for reconstruction.

Main Results:

• The modified approach provided adequate exposure of the sphenoid sinus while preserving septal structures.
• No complications such as mucosal perforation, septal deformity, or infection were observed.
• The technique was successfully applied in 47 cases, including pituitary adenomas, craniopharyngioma, and sphenoid mucocele.

Conclusions:

• This modified transseptal, transsphenoidal approach is safe and effective for accessing the sella turcica.
• It offers excellent exposure and minimizes complications.
• The technique facilitates reconstruction using resected bone from the sphenoid sinus wall.