Yaniv E, Rappaport Z H
Department of Otolaryngology, Rabin Medical Center, Petah Tiqva, Israel.
Neurosurgery. 1997 May;40(5):944-6. doi: 10.1097/00006123-199705000-00012.
Transseptal transsphenoidal surgery of pituitary tumors is a well-established surgical technique. The sublabial approach and the open rhinoplasty approach are most commonly used. In both cases, the surgical avenue is along the entire length of the nasal septum, removing both nasal cartilage and the vomer. Septal perforations and upper dental anesthesia are frequent complications of the standard approaches. We describe our initial experience in using the nasal endoscope for the first stage of the operation.
A nasal endoscope was used to open the anterior wall of the sphenoid sinus. Our initial incision was in the posterior third of the septum, removing only the vomer. After the sphenoid sinus was opened, we inserted a speculum and proceeded with the operation with an operating microscope. After the speculum was in place, it was easier to proceed with the microscope, which allows binocular vision and bimanual operation.
The procedure was used for our most recent 14 consecutive patients with pituitary adenomas. No complications related to the approach were encountered for any of the patients in follow-up monitoring.
The endoscopic transseptal approach to the sphenoid sinus for pituitary surgery was found to be easy, time-saving, and without septal or sublabial complications.
经鼻中隔经蝶窦垂体瘤手术是一种成熟的外科技术。最常用的是唇下进路和开放式鼻整形术进路。在这两种情况下，手术通道都沿着鼻中隔的全长，切除鼻软骨和犁骨。鼻中隔穿孔和上牙麻醉是标准手术方法常见的并发症。我们描述了我们在手术第一阶段使用鼻内镜的初步经验。
使用鼻内镜打开蝶窦前壁。我们最初的切口在鼻中隔后三分之一处，仅切除犁骨。打开蝶窦后，插入窥器，然后使用手术显微镜进行手术。窥器就位后，使用显微镜更容易操作，显微镜可提供双目视觉和双手操作。
该手术方法用于我们最近连续治疗的14例垂体腺瘤患者。在随访监测中，所有患者均未出现与手术进路相关的并发症。
经鼻内镜经鼻中隔入路行垂体手术治疗蝶窦病变，操作简便、省时，且无鼻中隔或唇下并发症。
