Microscopic paraseptal sphenoidotomy approach for pituitary tumors

Frank D. Vrionis, Donna Saatman, Jeffrey Sorenson, Steven Brem

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Dissection of mucosa from the nasal septum during a trans-sphenoidal approach may lead to significant morbidity. Endoscopic techniques that obviate this dissection and its complications have been successful for pituitary operations. These techniques, however, are generally not stereoscopic, can add significant costs, and in many instances require additional surgical personnel. Methods: We have exposed 11 sella lesions with the operating microscope without intranasal dissection or use of endoscopy. A paraseptal approach was utilized by following the middle turbinate to the nasopharynx and performing a bilateral sphenoidotomy. Results: Of the 11 sella lesions addressed through this approach, 6 were macroadenomas (2 secreting and 4 nonsecreting), 1 was a craniopharyngioma, 1 was a Rathke's cleft cyst, and 2 were cerebrospinal fluid leaks into the sphenoid sinus. In 1 case, an ectopic pituitary adenoma was biopsied. Subtotal or near total tumor resection or successful repair of cerebrospinal fluid leaks was achieved. In all cases, the exposure was satisfactory. A fat graft was used in 6 cases. Postoperatively, no nasal packing was used and there were no nasal complications. Vision improved in all 5 cases with preoperative visual impairment. Complications included diabetes insipidus (1), impaired taste (1), and delirium tremens (1), all of which were transient. Conclusions: Microscopic sphenoidotomy is a safe and effective alternative to traditional transseptal or endoscopic exposures of the sella.

Original languageEnglish (US)
Pages (from-to)223-231
Number of pages9
JournalCancer Control
Volume9
Issue number3
DOIs
StatePublished - Jan 1 2002

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Pituitary Neoplasms
Dissection
Nose
Central Nervous System Cysts
Alcohol Withdrawal Delirium
Sphenoid Sinus
Craniopharyngioma
Nasal Septum
Turbinates
Diabetes Insipidus
Nasopharynx
Vision Disorders
Endoscopy
Mucous Membrane
Fats
Morbidity
Transplants
Costs and Cost Analysis
Neoplasms
Cerebrospinal Fluid Leak

All Science Journal Classification (ASJC) codes

  • Hematology
  • Oncology

Cite this

Microscopic paraseptal sphenoidotomy approach for pituitary tumors. / Vrionis, Frank D.; Saatman, Donna; Sorenson, Jeffrey; Brem, Steven.

In: Cancer Control, Vol. 9, No. 3, 01.01.2002, p. 223-231.

Research output: Contribution to journalArticle

Vrionis, Frank D. ; Saatman, Donna ; Sorenson, Jeffrey ; Brem, Steven. / Microscopic paraseptal sphenoidotomy approach for pituitary tumors. In: Cancer Control. 2002 ; Vol. 9, No. 3. pp. 223-231.
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