Transnasal Endoscopic Approaches to the Sella Turcica

Introduction: Hypophyseal adenomas represent the most common neoplasic pathology seen at the National Institute of Neurology and Neurosurgery, in Mexico City. We present our experience in the use of transnasal endoscopic approaches to the sella turcica.

Methods: This program started in March 2005, and to date we have performed 150 procedures. The approach is made through one nasal passage with complete exposure of the sphenoid sinus and sella turcica. Since March 2007 we have been using a BrainLab navigational system, particularly because our cases normally involve grade IV lesions of the Hardy Vezina staging system. For CSF leaks, we have modified the UCLA protocol for reconstruction of the floor of the sella using a polypropylene mesh for supporting graft materials which include duragen, fat tissue, and bioglue, with an excellent outcome.The middle turbinate is placed back in position; no nasal packings are used.

Results: A statistical analysis is made by comparing these results with those obtained with the classical transseptal approaches in our institution.

Conclusions: Transnasal endoscopic approaches offer much better results regarding complete resection in comparision with the classical transseptal surgery.