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1 results

  • Modified transseptal approach in endoscopic transsphenoidal pituitary surgery

  • R Gan, S Stokes, A Bahl, J Jose
  • Journal:
    The Journal of Laryngology & Otology / Volume 137 / Issue 12 / December 2023
    Published online by Cambridge University Press:
    17 February 2023, pp. 1409-1412
    Print publication:
    December 2023
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  • 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.