Transnasal, transeptal sphenoidal approach to hypophysectomy.

Since 1960 the most useful and widely employed technique for transphenoidal hypophysectomy has generally been via the sublabial, transeptal approach. This procedure has offered excellent exposure, limited blood loss and a direct, midline approach through the sphenoid to the hypophysis, thus preserving certain midline structures as a guide to the appropriate point of entry into the sella turcica. This approach has certain drawbacks, however, not the least of which is the extensive sublabial incision that must be made and the need to remove or otherwise interfere with the nasal spine. This maneuver can result in changes in the vertical dimension of the septal-collumellar area and, more important, often results in permanent numbness of the upper teeth. In patients who wear dentures, it will sometimes produce a bothersome scar which will require refitting or change in wearing patterns for these dentures. It also requires surgical closure. For the past two years at the Cleveland Clinic Foundation a modified transeptal, transphenoidal approach to hypophysectomy has been undertaken conjointly between the Department of Otolaryngology and Communicative Disorders and the Department of Neurosurgery. This approach to hypophysectomy may offer a good alternative to the sublabial approach, and in competent hands avoids some of the complications of the latter procedure.