A Modified Combined Transseptal/Transnasal Binostril Approach for Pituitary Lesions in Patients with a Narrow Nasal Space: Technical Note |
| |
Authors: | Mitsuhiro TAKEMURA Yasunori FUJIMOTO Taisuke KOBAYASHI Masahiro KOMORI Aldo C STAMM Eduardo VELLUTINI Pedro MARIANI Yu KAWANISHI Keiji SHIMIZU |
| |
Affiliation: | 1.Department of Neurosurgery, Kochi Medical School, Kochi University, Nankoku, Kochi;;2.Department of Otorhinolaryngology, Kochi Medical School, Kochi University, Nankoku, Kochi;;3.São Paulo ENT Center, Complexo Hospitalar Edmundo Vasconcelos, São Paulo, Brazil;;4.Department of Neurosurgery, DFV NEURO, São Paulo, Brazil;;5.Department of Neurosurgery, Hospital Euryclides de Jesus Zerbini, São Paulo, Brazil |
| |
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 nonfunctioning 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. |
| |
Keywords: | endoscopic endonasal surgery pituitary lesions narrow nasal space modified Stamm''s approach two-surgeon four-handed technique |
|
|