Endoscopic Transseptal Transsphenoidal Surgery for Pituitary Tumors: A Double-Center Preliminary Experience

Introduction: Endoscopic transsphenoidal pituitary surgery is a diffuse and well established surgical technique: over the years, the transseptal approach via a nasal mucosal incision has also gained popularity. Here we describe our preliminary experience with an entirely endoscopic transseptal transsphenoidal approach via an incision in the nasal mucosa for sellar tumor resection.

Methods: A total of 35 patients, with a midline prevalent sellar tumor, who underwent endoscopic transsphenoidal transpetal pituitary surgery from January 2023 to May 2024 were reviewed for evaluation of the safety and efficacy of this approach. The surgical corridor is along the entire length of the nasal septum and an endoscope was used since the initial phases of the procedure.

Results: At follow-up, no CSF leaks and no nasal mucosa scarring related to the approach were registered and a low rate of nasal complications occurred: one septal perforation and one mucosal dehiscence. The low-rate of postoperative nasal morbidity was also confirmed by the single case of post-procedural synechia; although the occurrence of a longer operating time in the first cases, globally the transeptal approach did not result in a time-consuming technique and a better cosmetic result was noticed at follow-up.

Conclusion: This study confirms, in our experience, the excellent risk-benefit ratio supporting the use of trans-sphenoidal endoscopic transseptal approach in selected cases: this working corridor for pituitary surgery was found to be easy for an experienced multidisciplinary team providing good maneuverability and effective therapeutic approach.

Publication History

Article published online:
07 February 2025