Middle turbinectomy for exposure in endoscopic endonasal transsphenoidal surgery: when is it necessary?

OBJECTIVES

To evaluate the benefits of middle turbinectomy on the exposure of the skull base structures.

DESIGN

An anatomical study on 20 fresh cadaver heads.

METHODS

The extent of the exposure of the skull base structures during endoscopic endonasal approach has not been addressed specifically in respect to the whether or not the middle turbinectomy is performed. We compared the extent of exposure obtained by endonasal transsphenoidal approaches without middle turbinectomy (NMT), with unilateral turbinectomy (UMT), and with bilateral turbinectomy (BMT). Our preselected target points in the skull base consisted of sella turcica, tuberculum sella, planum sphenoidale, clivus (upper and middle third), and ipsilateral sphenopalatine artery (SPA).

RESULTS

Of our preselected anatomic target points, only the middle third of the clivus and ipsilateral SPA had enhanced exposure in UMT (100% for both structures) compared to NMT (45% and 20%, respectively). The addition of a BMT did not provide added exposure to any target compared with a UMT.

CONCLUSIONS

Middle turbinectomy may not be necessary for endonasal transsphenoidal approach to the lesions of the sella, planum sphenoidale, and upper third of the clivus. However, gaining access to the middle clival region is facilitated by resection of middle turbinate.