PDF icon Download PDF
J Neurol Surg B Skull Base 2014; 75(06): 415-420
DOI: 10.1055/s-0034-1383855
Original Article
Georg Thieme Verlag KG Stuttgart · New York

The Endoscopic Hemi-Transseptal Approach to the Sella Turcica: Operative Technique and Case-Control Study

Marc A. Tewfik
1   Department of Otolaryngology – Head and Neck Surgery, McGill University, Jewish General Hospital, Montreal, Canada
2   Department of Otolaryngology – Head and Neck Surgery, McGill University, McGill University Health Center, Montreal, Canada
,
Constanza J. Valdes
1   Department of Otolaryngology – Head and Neck Surgery, McGill University, Jewish General Hospital, Montreal, Canada
3   Department of Otolaryngology – Head and Neck Surgery, Universidad de Chile, Hospital del Salvador, Chile
,
Anthony Zeitouni
2   Department of Otolaryngology – Head and Neck Surgery, McGill University, McGill University Health Center, Montreal, Canada
,
Denis Sirhan
4   Department of Neurosurgery, McGill University, Montreal Neurological Hospital, Montreal, Canada
,
Salvatore Di Maio
5   Division of Neurosurgery, McGill University, Jewish General Hospital, Montreal, Canada
› Author Affiliations
Further Information

Publication History

25 July 2013

06 May 2014

Publication Date:
27 June 2014 (online)

Also available atMedOne
   Permissions and Reprints
Preview

Abstract

Background The hemi-transeptal (Hemi-T) approach was developed to facilitate a binasal two-surgeon endoscopic approach for sellar tumors, with preservation of the nasoseptal flap and selective mobilization for reconstruction.

Methods A retrospective case-control study was performed comparing the Hemi-T approach with previously used methods of sellar exposure and reconstruction. Outcome measures included operative time and postoperative nasal morbidity.

Results A total of 23 patients underwent the Hemi-T approach versus 42 in whom traditional exposure was performed. Operative time was significantly shorter using the Hemi-T technique (152.6 ± 56.8 versus 205.2 ± 61.3 minutes; p = 0.001), as was the length of hospital stay (3.3 ± 1.9 versus 5.4 ± 3.6 days; p = 0.004). There was no difference in the rates of intraoperative or postoperative cerebrospinal fluid leak, cartilage necrosis, septal perforation, or mucosal adhesions.

Conclusion The Hemi-T approach facilitates binasal two-surgeon access to the sella without compromise of the pedicle during the extended sphenoidotomies and tumor removal. Operative time and nasal morbidity is not increased, and iatrogenic injury to the nasal cavity is minimized when a flap is not required.

Keywords

skull base defect - CSF rhinorrhea - endoscopic skull base surgery - reconstruction - nasoseptal flap