Endoscopic transseptal transsphenoidal surgery for pituitary tumors

Transseptal transsphenoidal surgery of pituitary tumors is a well-established surgical technique. The sublabial approach and the open rhinoplasty approach are most commonly used. In both cases, the surgical avenue is along the entire length of the nasal septum, removing both nasal cartilage and the vomer. Septal perforations and upper dental anesthesia are frequent complications of the standard approaches. We describe our initial experience in using the nasal endoscope for the first stage of the operation.

A nasal endoscope was used to open the anterior wall of the sphenoid sinus. Our initial incision was in the posterior third of the septum, removing only the vomer. After the sphenoid sinus was opened, we inserted a speculum and proceeded with the operation with an operating microscope. After the speculum was in place, it was easier to proceed with the microscope, which allows binocular vision and bimanual operation.

The procedure was used for our most recent 14 consecutive patients with pituitary adenomas. No complications related to the approach were encountered for any of the patients in follow-up monitoring.

The endoscopic transseptal approach to the sphenoid sinus for pituitary surgery was found to be easy, time-saving, and without septal or sublabial complications.