title: How to Expose the Entire Sella Floor With Minimal Manipulation During an Endoscopic Endonasal Transsphenoidal Approach.
abstract: OBJECTIVE
  A method of opening the posterior ethmoid air cells with minimal manipulation is important for adequate exposure of the sella floor and minimal nasal morbidity.
  
  
  METHODS
  Between February 2009 and August 2016, 373 patients with skull-base tumors underwent surgery via endoscopic endonasal transsphenoidal approach with the 2-nostrils/4-hands technique using this technique.
  
  
  RESULTS
  A linear incision was made laterally toward one-third of the superior turbinate along the superior border of the sphenoid sinus ostium. Then, the superior turbinate mucosa was fully elevated to expose the superior turbinate bone. This allowed us to expose the entire sella floor and adjacent vital structures, such as the optic and carotid protuberances, medial and lateral opticocarotid recesses, planum sphenoidale, and clivus, leaving the superior turbinate and surrounding nasal mucosa intact.
  
  
  CONCLUSIONS
  This technique could improve the manipulability of surgical instruments and increase the accessibility of the parasellar region. This approach better conserves the nasal mucosa, posterior ethmoid, and superior and supreme turbinates and more efficiently exposes skull-base tumors than traditional methods with pathology of the anterior cranial fossa and parasellar region. This technique also prevents the drilling procedure from damaging the surrounding nasal mucosa, including the exfoliated and laterally preserved posterior sphenoid mucosa.
authors.affiliation: *Department of Otolaryngology, Head and Neck Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea †Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea ‡Department of Otolaryngology, Head and Neck Surgery, Uijeongbu St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Kim
authors.forename: Yong-Kil
authors.initials: YK
authors.lastname: Hong
authors.forename: Sin-Soo
authors.initials: SS
authors.lastname: Jeun
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Park
authors.forename: Soo Whan
authors.initials: SW
authors.lastname: Kim
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Cho
authors.forename: Boo-Young
authors.initials: BY
authors.lastname: Kim
authors.forename: Sung Won
authors.initials: SW
authors.lastname: Kim
mesh_terms: D035262:Cranial Fossa, Anterior / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D009296:Nasal Cavity; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000601:surgery*; D013100:Sphenoid Bone / Q000601:surgery*