Microscopic paraseptal sphenoidotomy approach for pituitary tumors.
BACKGROUND
Dissection of mucosa from the nasal septum during a transsphenoidal approach may lead to significant morbidity. Endoscopic techniques that obviate this dissection and its complications have been successful for pituitary operations. These techniques, however, are generally not stereoscopic, can add significant costs, and in many instances require additional surgical personnel.


METHODS
We have exposed 11 sella lesions with the operating microscope without intranasal dissection or use of endoscopy. A paraseptal approach was utilized by following the middle turbinate to the nasopharynx and performing a bilateral sphenoidotomy.


RESULTS
Of the 11 sella lesions addressed through this approach, 6 were macroadenomas (2 secreting and 4 nonsecreting), 1 was a craniopharyngioma, 1 was a Rathke's cleft cyst, and 2 were cerebrospinal fluid leaks into the sphenoid sinus. In 1 case, an ectopic pituitary adenoma was biopsied. Subtotal or near total tumor resection or successful repair of cerebrospinal fluid leaks was achieved. In all cases, the exposure was satisfactory. A fat graft was used in 6 cases. Postoperatively, no nasal packing was used and there were no nasal complications. Vision improved in all 5 cases with preoperative visual impairment. Complications included diabetes insipidus (1), impaired taste (1), and delirium tremens (1), all of which were transient.


CONCLUSIONS
Microscopic sphenoidotomy is a safe and effective alternative to traditional transseptal or endoscopic exposures of the sella.
Vrionis
Frank D
FD
Department of Neurosurgery, University of South Florida and H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA. vrionif@moffitt.usf.edu
Saatman
Donna
D
Sorenson
Jeffrey
J
Brem
Steven
S
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010911:Pituitary Neoplasms / Q000601:surgery*; D013100:Sphenoid Bone / Q000601:surgery*