The transethmoidal-transsphenoidal route to the pituitary gland. Technique, advantages, limitations and possible complications.

The technique of the transethmoidal-transsphenoidal approach to the pituitary gland is described stepwise. The importance of a thorough preoperative radiological work-up and a preoperative X-ray image-intensifying control is outlined. The greatest disadvantages of the transethmoidal route are the extra-axial approach and the external scar. The greatest advantages are the shorter route than in the transseptal approach, the absence of endonasal complications and the minimal postoperative discomfort. In the own patient material consisting of 26 patients where a pituitary adenoma was removed, we noted no mortality, no meningitis and no endonasal complications. There were two cases of postoperative C.S.F. leak and one case of amaurosis and ophthalmoplegia of the heterolateral eye.