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Modified transseptal approach in endoscopic transsphenoidal pituitary surgery

Published online by Cambridge University Press:  17 February 2023

R Gan Open the ORCID record for R Gan [Opens in a new window] ,
S Stokes ,
A Bahl  and
J Jose
R Gan*
Affiliation:
Ear, Nose & Throat Department, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
S Stokes
Affiliation:
Neurosurgery Department, Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, UK
A Bahl
Affiliation:
Neurosurgery Department, Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, UK
J Jose
Affiliation:
Ear, Nose & Throat Department, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
*
Author for correspondence: Mr Richard Gan, ENT Department, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Castle Road, Cottingham HU16 5JQ, UK E-mail: richardwcgan@gmail.com
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Abstract

Objective

Transsphenoidal pituitary surgery is commonly performed via a direct transostial approach with a posterior septectomy. However, a technique via an endoscopic transseptal route has been described that avoids a posterior septectomy, but it comes with its own disadvantages.

Methods

This paper describes a modification, and discusses its pros and cons.

Results

The initial incision in the mucosa is placed level with the anterior middle turbinate. The mucoperichondrial flap is raised ipsilaterally until the sphenoid sinus ostium. An incision is made at the osseocartilaginous junction, and the contralateral mucoperichondrial flap is raised. The bony septum and posterior aspect of this flap is excised. The size and position of this window can be adapted. At the end of the operation, the lateralised intact mucoperichondrial flap is moved back to the midline.

Conclusion

Excision or deflection of the cartilaginous septum is not required. It maintains an intact septal mucosa on one side and avoids a septal perforation.

Keywords

Pituitary NeoplasmEndoscopic Surgical ProceduresPituitary Adenoma
Type
Short Communications
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 12 , December 2023 , pp. 1409 - 1412
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Mr R Gan takes responsibility for the integrity of the content of the paper

References

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