Microsurgical Resection of Pituitary Adenoma via Single-Nostril Transsphenoidal Approach

• Published in: Clinical oncology and cancer research Vol. 6; no. 6; pp. 446 - 450
• Main Authors: Zhang, Hengzhu, Zhang, Xian, Du, Hongmei, Wu, Yongkang, Dun, Lun, She, Lei, Wang, Xiaodong, Shi, Xueqiang, Xu, Cunlin
• Format: Journal Article
• Language: English
• Published: Heidelberg Tianjin Medical University Cancer Institute and Hospital 01.12.2009; Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou 225001, Jiangsu Province, China
• Subjects: Medicine; Medicine & Public Health; Oncology; 临床病理; 垂体腺瘤; 手术切除; 气相色谱; 治疗效果; 病理特征; 肿瘤浸润; pituitary adenoma; transsphenoid approach; microsurgery; single-nostril
• ISSN: 1674-5361; 1868-324X
• DOI: 10.1007/s11805-009-0446-7

OBJECTIVE To explore the methods and experience of the single-nostril transsphenoidal approach for treating pituitary adenomas. METHODS We retrospectively analyzed 46 patients who had pituitary tumors and received surgery via the singlenostril transsphenoidal approach and observed the effects and complications of surgery. The specific surgical methods are： a nasal speculum is inserted slowly through the right nostril towards the anterior wall of the sphenoid sinus. A 1.5 cm incision is made into the nasal mucosa in the right nasal cavity at the level of the middle nasal turbinate. By fracturing the bony septum, a space is formed between the bilateral nasal mucosa and the bony septum of the sphenoid sinus. Then, the inside of the sphenoid sinus is exposed. The remaining part of the bony septum, the anterior sphenoid sinus wall, and the sphenoid mucosa are gradually removed. The anterior sphenoidotomy is less than 1.5 cm wide. After confirming the tumor by dural puncture, a cross incision of the dura is made, and the tumor is slowly removed by curette. The sella is usually collapsed and visible after the total tumor removal. When the tumor is resected satisfactorily, gelatin sponges are placed into the operative cavity to stop bleeding. RESULTS Postoperative MRI scans revealed that among the 46 cases, total resection of the tumor was achieved in 34 cases and subtotal in 12. No deaths or disability occurred, and the hormone levels of almost all patients improved. Signs of diabetes insipidus occurred in 17, electrolyte disturbances in 5, and there were no reports of postoperative cerebrospinal fluid rhinorrhea. CONCLUSION The direct single nostril transsphenoidal approach of continuous improvement has the advantages of a convenient approach, simplified operation, safety and high efficiency.