Resection and Reconstruction of Nasal Turbinates in Endoscopic Endonasal Transpterygoid Approach

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Background: Endoscopic endonasal approaches (EEAs) are extending laterally from the median to paramedian skull base by using a transpterygoid approach. This approach traditionally included resection of the lateral nasal wall such as middle and inferior turbinates at the nasal phase. Nasal turbinates take an important role such as warming and humidification of air and autopurification of nasal mucosa. We started to reconstruct nasal turbinates in the transpterygoid approach after March 2013. We demonstrate the surgical technique and compared the visualization of this working space in the resection group with the reconstruction group. Methods and Surgical Technique: We performed a retrospective analysis of prospectively collected data of patients undergoing endoscopic endonasal transpterygoid approach from April 2010 to July 2015. We cut the inferior turbinate and partial middle turbinate until March 2013 in resection group. We started to reconstruct these turbinates after March 2013 in reconstruction group. We cut the anterior attachment of inferior and middle turbinate at the first step and swung back to the pharyngeal space or swung lateral to maxillary sinus. Then we made the transsphenoidal and transpterygoid corridor. We reconstructed the both turbinates at the last step by suturing. All patients were cared postoperatively by endonasal fiberscope and scanned by CT or MRI. We checked the condition of nasal turbinates. Results: A total of 21 (19 patients, 12 males, 7 females) nasal sides were enrolled. The mean age of the patients was 54 years (range, 4–81 years). The pathologies were chordoma in 8 patients, neurinoma in 3, meningioma in 3, encephalocele in 2, pituitary adenoma in 2, and chondrosarcoma in 1. 8 nasal sides were in resection group and 13 sides were in reconstruction group. Both resection group and reconstruction group could obtain the clear view and wide working space during operation. All turbinates in reconstruction group were preserved at 6 months after operation. Conclusions: Nasal turbinate reconstruction in endoscopic endonasal transpterygoid approach combined with transsphenoidal approach can provide not only wide working space and clear view, but also preservation of nasal anatomic structures at the end of operation.