Middle Turbinate Preservation in Endoscopic Transsphenoidal Surgery of the Anterior Skull Base

Introduction: One of the key principals of endoscopic endonasal skull base surgery is the creation of a large cavity, often centered around the sphenoid sinus, in which the surgeon can place the endoscope and maneuver the instruments. Resection of the middle and/or superior turbinate on one and sometimes both sides is often recommended. These structures, however, play an important role in sinonasal function and olfaction. Since preservation of function is critical in minimal access surgical approaches, we attempted to preserve the turbinates in a series of endonasal skull base cases.

Methods: A prospective database was reviewed for all cases of purely endoscopic transsphenoidal surgery done at a single tertiary-care institution.

Results: One hundred forty-six consecutive cases of purely endoscopic transsphenoidal surgery were selected from a larger endoscopic skull base database. In 100% of these cases both middle and superior turbinates were preserved. The cases included: 97 pituitary tumors, 17 cerebrospinal fluid leak repairs, 13 craniopharyngiomas, 11 meningiomas, and 8 clival tumors. Of the tumor cases 74% had a gross total resection and 23% had a subtotal resection. Average tumor size was 2.3 cm (0.2 to 8 cm). Follow-up was for a minimum of 3 months to allow postoperative imaging in tumor cases. Using various reconstructive techniques, only one case required reoperation for cerebrospinal fluid leak.

Conclusions: The middle turbinate can be preserved in nearly every transsphenoidal case and still provide adequate exposure for successful tumor resection and skull base reconstruction.