title: A modified combined transseptal/transnasal binostril approach for pituitary lesions in patients with a narrow nasal space: technical note.
abstract: We describe a modification of the combined transseptal/transnasal binostril approach using a two-surgeon, four-handed technique (modified Stamm's approach) for pituitary lesions in patients with narrow nasal spaces. This approach comprises of a transseptal route through one nostril and a transnasal route without harvesting a pedicled nasoseptal flap (NSF) through the other. On the transseptal side, the nasal septum was removed using an endoscopic septoplasty technique. On the transnasal side, the mucosa containing the septal branch of the sphenopalatine artery over the face of the sphenoid and nasal septum was preserved for harvesting the NSF if an intraoperative cerebrospinal fluid leak was encountered. This approach was performed in six patients with pituitary lesions, including four non-functioning macroadenomas, one growth hormone-producing macroadenoma, and one Rathke's cleft cyst, all of which were associated with a severe deviation of the nasal septum and/or narrow nasal space. The meticulous and comfortable manipulation of an endoscope and instruments were achieved in all six patients without surgical complications. Our findings, although obtained in a limited number of cases, suggest that the modified Stamm's approach may be useful for selected patients, particularly those with a severe deviation of the nasal septum, without considerable damage to the nasal passages.
authors: Department of Neurosurgery, Kochi Medical School, Kochi University.
authors: Mitsuhiro
authors: M
authors: Takemura
authors: Yasunori
authors: Y
authors: Fujimoto
authors: Taisuke
authors: T
authors: Kobayashi
authors: Masahiro
authors: M
authors: Komori
authors: Aldo C
authors: AC
authors: Stamm
authors: Eduardo
authors: E
authors: Vellutini
authors: Pedro
authors: P
authors: Mariani
authors: Yu
authors: Y
authors: Kawanishi
authors: Keiji
authors: K
authors: Shimizu
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D020863:Central Nervous System Cysts / Q000601:surgery*; D003299:Cooperative Behavior; D004724:Endoscopy / Q000379:methods*; D005260:Female; D058733:Hand-Assisted Laparoscopy; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000601:surgery*; D009666:Nose / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D013101:Sphenoid Sinus / Q000601:surgery*; D013524:Surgical Flaps / Q000601:surgery