Binasal Endoscopic Approach to the Sellar Region: Experience and Outcome Analysis of 80 Cases

Abstract

A prospective study was performed on 80 cases of different types of sellar lesions during the period between January 2007 and December 2010. The binasal approach was used in all patients. Functioning lesions were diagnosed in 59 patients. The most common secretory tumors were prolactinomas (37 patients) followed by adrenocorticotropic hormone producing tumors (11 patients) and growth hormone producing tumors (11 patients). Nonfunctioning lesions included: 14 pituitary adenomas, 2 chordomas, 2 metastatic lesions (ovarian carcinoma and thyroid carcinoma), and 1 case of sarcoidosis, Rathke's cleft cyst, and craniopharyngioma. Seven nonfunctioning cases developed apoplexy. Among the 59 patients with functioning pituitary lesions, postoperative endocrinological control was achieved in 51 of them (86.5%) 3 months postoperatively with normalization of pituitary functions and complete tumor resection as proved by postoperative magnetic resonance imaging. Postoperative visual field defect improvement was achieved in 15 out of 23 patients (65.2%), including the cases with apoplexy, with complete tumor resection. Postoperative discomfort such as headache, vomiting, or dizziness was minimal and hospitalization period was 2 to 3 days. Postoperative leak continued in one patient in whom revision surgical repair was performed 7 days later. The merits, outcome, and limitations of the approach were discussed.

Comparing Mononostril, Binostril, and One and a Half Nostril Endoscopic Transsphenoidal Approach for Treating Pituitary AdenomaPituitary Adenoma

“…In the META, because of using one side of the nasal cavity, the surgical field is more restricted and limited, and there is a struggle between the endoscope and surgical instruments as in macroadenoma with parasellar extension, and it is better to approach from contralateral nostril about the surgical target area. In OETA, moving the endoscope to the contralateral nostril concerning the surgical target area creates a tremendous surgical field view, spacious wide surgical field, and sufficient space for the free movement of instruments [8,20,[34][35][36][37].…”

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Approach to the Sellar and Parasellar Regions

“…The endoscopic technique demands different surgical skills and a new anatomical perspective that differ from the traditional microscopic training in skull base surgery. 6 Although several publications describing the EEAs to these regions are available, 2,4,5,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] most of them offer a general anatomical overview of the approach, without providing a modular, detailed, and step-by-step description as the images available may portray non-operative exposures and perspectives. Consequently, the main goal of this study is to develop an educational resource to help trainees understand the pertinent anatomy and procedural steps of the EEAs to the sellar and parasellar regions.…”

Evaluation of Surgical Freedom for One-and-a-Half Nostril, Mononostril, and Binostril Endoscopic Endonasal Transsphenoidal Approaches

“…3,5 The binostril approach, allowing a four-handed technique and more flexible movement to lateral anatomy, was advocated by Kassam et al 6 and had been far and away the most common approach for pituitary adenomas, especially in cases of expanded endoscopic transnasal approaches. [7][8][9] The mononostril endoscopic transsphenoidal approach (META) offered a minimal injury to nasal cavity at a cost of surgical manipulation space which is restricted by the interferences between instruments. Limited surgical corridors and nasal turbinates make it difficult to angle instruments to the extreme lateral parasellar region.…”