Professor of Rhinology & Skull Base Surgery, Ain Shams University, Cairo, Egypt
Department of Oto-Rhino-Laryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
|
Home Page of Prof.
Mohamed Zaki Helal
|
Professor of Rhinology & Skull Base Surgery, Ain Shams University, Cairo, Egypt Department of Oto-Rhino-Laryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt. |
The transsphenoid approach is the standard approach to the sella and parasellar region of the skull base.
The transseptal and the paraseptal sphenoidotomy routes are direct midline approaches and therefore safer than oblique approaches such as the trans-ethmo-sphenoid approach.
The advantages of microscopes and endoscopes are highlighted together with the differences, indications and advantages of using transseptal and paraseptal routes.
Since 1989, over 600 pituitary adenomas (Macroadenomas:Microadenomas=about 5:1) underwent selective adenomectomy with preservation of the normal glandular tissues.
The transseptal transsphenoid approach was used in patients with pituitary microadenomas and in patients with macroadenomas less than 2 cm in diameter.
The paraseptal transsphenoid approach was used for macroadenomas above 2 cm in diameter.
In transseptal approach endoscopes; straight and angled; were used in all steps while the microscope is used sometimes during tumor dissection. In paraseptal approach endoscopes were exclusively used.
The endoscopic view provides superior perception of anatomy, and therefore avoidance of possible complications. Parasellar, presellar and suprasellar extensions of macroadenomas were best dealt with under endoscopic control and angled endoscopes were proved be superior to 00 endoscope in this respect.
The microscopic view with its magnification and antireflective nature of its lens system provides superior perception of tissue fine details and with its stable operative view is suitable for in focus free bimanual delicate manipulation of midline structures such as in dissection of tumor capsule from dura and arachnoid.
The paraseptal approach has been superior for large macroadenomas with parasellar extensions.
The transseptal approach has
been superior in preserving nasal anatomy, mucosa and function being an
extramucosal route respecting nasal mucosa and preserving middle turbinates. It
also provides the combined use of microscopes and endoscopes.
"Endoscopic Transsphenoid Excision Of Pituitary Macroadenoma: 1- Approach"
"Endoscopic Transsphenoid Excision Of Pituitary Macroadenoma: 2- Dissection"
"Endoscopic Transsphenoid Excision Of Pituitary Macroadenoma: 3- Reconstruction"
