Sublabial Transseptal Approach Research Articles

Endoscopic endonasal transsphenoidal hypophysectomy: two hand versus four hand technique: our experience.

An endoscope was used in transsphenoidal surgery and eventually replaced the operating microscope as a tool for visualization. Initially patients underwent operation via a sublabial transseptal approach using a rigid endoscope in conjunction with an operating microscope. The subsequent operations were performed through a nostril using only rigid endoscopes, initially through single nostril by one surgeon (two hands) and later through both nostrils by two surgeons (four surgeons). This is a retrospective study of 96 patients who had pituitary adenomas in last ten years. Postoperatively all patients who had undergone endonasal endoscopic surgery had unobstructed nasal airways with minimal discomfort. More than half of the patients required only an overnight hospitalization.

Sublabial Transseptal vs Transnasal Combined Endoscopic Microsurgery in Patients With Cushing Disease and MRI-Depicted Microadenomas

To assess whether the type of surgical approach to the sella (sublabial transseptal vs transnasal) affects surgical outcome among patients with Cushing disease. Both procedures were performed at our institution from January 1, 1995, through January 31, 2003. From a total of 106 patients with Cushing disease who had had surgery, we identified 42 adults undergoing an initial surgery, with microadenoma (<1 cm) determined by magnetic resonance imaging and a minimal follow-up of 3 months. We identified 21 patients (4 male, 17 female) for sublabial transseptal transsphenoidal microsurgery. Mean+/-SD age was 45.0+/-12.9 years (range, 27.0-69.0 years); median duration of symptoms was 2.5 years (range, 1.5-7.5 years). Median follow-up was 1.0 year (range, 0.3-11.0 years). We identified another 21 patients (5 male, 16 female) for endoscopic transsphenoidal microsurgery whose mean+/-SD age was 43.8+/-14.1 years (range, 19.0-70.0 years); median duration of symptoms was 2.4 years (range, 0.2-6.0 years). Median follow-up was 2.5 years (range, 0.3-8.7 years). Complications (cerebrospinal fluid leak and transient diabetes insipidus) and cure (86% initial cure; 76% relapse-included cure) were equivalent between the 2 procedures. However, the endoscopic approach was associated with shorter anesthesia time, less blood loss, and shorter hospital stays. The endoscopic transnasal surgical approach led to shorter total anesthesia time, less blood loss, and shorter hospital stay when compared with the sublabial transseptal approach. However, we found no difference between the 2 surgical procedures with respect to cure or complications, suggesting that outcome is more closely related to the experience of the operating team.

Comparison of Techniques for Transsphenoidal Pituitary Surgery

The aim of this study was to compare three different techniques for transsphenoidal pituitary surgery: (1) sublabial transseptal approach with microscopic resection, (2) transnasal transseptal approach with endoscopic resection, and (3) endoscopic approach with endoscopic resection. We performed a retrospective review of 50 pituitary surgeries performed by the same neurosurgeon. Demographic, radiographic, and clinical data were collected. Fifteen patients underwent sublabial approach with microscopic tumor resection, 21 patients underwent the transnasal approach with endoscopic resection, and 14 patients underwent the completely endoscopic technique. There were a total of 20 complications in the sublabial group, 13 transnasal complications, and 6 endoscopic complications. Cerebrospinal fluid leak incidence was 53% in the sublabial approaches, 47% transnasal, and 28% in the endoscopic patients. Diabetes insipidus was encountered in 33% of sublabial approaches, 5% of transnasal approaches, and 7% of endoscopic approaches. Lumbar drains were required in 40% of sublabial approaches, 38% of transnasal approaches, and 7% of endoscopic approaches. Nasal packing was used in 100% of sublabial and transnasal approaches and 0% of endoscopic approaches. Mean recurrence rate and follow-up was sublabial in 6.6% (50 months), transnasal in 9.5% (11 months), and endoscopic in 0% (7 months). Average hospital stay for sublabial approaches, transnasal approaches, and endoscopic approaches was 8.3, 6.2, and 3.4 days, respectively (p < 0.05). Transsphenoidal pituitary surgery has evolved over the past several decades, because advances in technology have been the catalyst for minimally invasive surgeries. Less invasive approaches, such as the transnasal approach with endoscopic resection of tumor and the completely endoscopic .technique have less morbidity and a shorter hospital stay than traditional sublabial approaches. Continued follow-up is needed to confirm long-term benefits and similar recurrence rates.

Surgical techniques in transsphenoidal surgery: what is the standard of care in pituitary adenoma surgery?

Purpose of review The transsphenoidal approach represents the standard of care for the overwhelming majority of pituitary adenomas. Recently several surgical adjuncts and variations on the transsphenoidal technique have been described. Recent findings The versatility of the transsphenoidal corridor is exemplified by the variety of approaches available. Microscopic adenomectomies are currently performed by use of the traditional sublabial transseptal approach, the endonasal transseptal approach, or several direct transnasal approaches. The introduction of pure endonasal endoscopic transsphenoidal adenomectomy represents a new phase in the evolution of the transsphenoidal approach. The surgical approach can be facilitated by frameless stereotaxy, and the extent of tumor resection can be assessed by several modalities, including endoscopy, ultrasonography, and intraoperative MRI. Each of these technical adjuncts has unique advantages and drawbacks. Summary Amid the variety of transsphenoidal approaches and technical adjuncts, it is only the corridor itself that currently can be called the standard of care. Each approach and adjunct has its place in specific clinical situations. The versatile surgeon who has access to and is comfortable with each will be able to provide the ideal care for each patient.

The sublabial transseptal approach to the pituitary gland

Pituitary surgery is best performed by combining the expertise of otolaryngology and neurosurgery. Proper preoperative assessment and attention to the details of surgical technique will result in avoiding potential life-threatening complications. The sublabial transseptal approach to the sella turcica provides an effective and safe approach to the pituitary gland. A comparison with the endoscopic approach is also presented.

Diabetes Insipidus after Pituitary Surgery: Incidence after Traditional versus Endoscopic Transsphenoidal Approaches

The endoscopic transnasal approach is gaining increasing popularity as the surgical method of choice for treatment of pituitary lesions. Previous studies have shown advantages such as quicker recovery and fewer cosmetic, dental, and nasal complications. However, no study has compared the rate of diabetes insipidus (DI) between the traditional and endoscopic approaches. This study will examine the incidence of short- and long-term postoperative DI after transnasal pituitary surgery and compare it with the incidence after traditional transseptal surgery. Eighty-one patients underwent transnasal surgery for the management of pituitary lesions. Fifty-five had the traditional sublabial, transseptal, transsphenoidal surgery and 26 patients had the direct transnasal, transsphenoidal endoscopic procedure. The incidence of immediate postoperative DI was 36% in the traditional group and 15% in the endoscopic group. Short-term (>2 weeks) DI that required treatment occurred in 11 patients (20%) in the traditional group and 2 patients (7.6%) in the endoscopic group. Long-term (>6 months) incidence of DI was 7.2% in the traditional group and 3.8% in the endoscopic group. We found a decreased incidence of immediate DI after transnasal endoscopic pituitary surgery as compared with the traditional sublabial transseptal approach. However, the incidence of long-term DI was not significantly different in the two groups.

Inverting papilloma of the sphenoid sinus: report of two cases

Two patients with sphenoid sinus inverting papilloma who were treated either by transcranial or sublabial trans-septal approach are reported. Inverting papillomas arising from the sphenoid sinus are exceedingly rare. The clinical and neuro-imaging featu res, as well as surgical treatment, for sphenoid sinus tumours are also briefly discussed.

Preliminary Comparison of the Endoscopic Transnasal vs the Sublabial Transseptal Approach for Clinically Nonfunctioning Pituitary Macroadenomas

To assess the advantages and disadvantages of an endoscopic transnasal approach to pituitary surgery for a select group of clinically nonfunctioning macroadenomas and to compare results of this approach with the sublabial transseptal approach at a single institution. We retrospectively reviewed the records of 26 patients with clinically nonfunctioning pituitary macroadenomas approached endoscopically and 44 matched control patients with the same tumors approached sublabially between January 1, 1995, and October 31, 1997. At baseline, the groups were not significantly different for age, sex distribution, number of comorbid conditions, visual field defects, degree of anterior pituitary insufficiency, or preoperative assessment of tumor volume or invasiveness. Mean (SD) operative times were significantly reduced in the endoscopic group vs the sublabial group: 2.7 (0.7) hours vs 3.4 (0.9) hours (P < .001). Postoperative assessment of surgical resection and postoperative alterations of anterior pituitary function or visual fields were not significantly different between groups, and complication rates were similar in both groups. This endoscopic transnasal approach to pituitary resection results in significantly shorter operative time without compromising the extent of tumor resection. The distinct disadvantage of this approach is an off-center view of the sella and a diminished working channel to the sella turcica. For these reasons, the endoscopic approach or its variation is an alternative to the sublabial approach but should be considered only by experienced pituitary neurosurgeons.

Endoscopic endonasal transsphenoidal surgery: experience with 50 patients

An endoscope was used in transsphenoidal surgery and eventually replaced the operating microscope as a tool for visualization. Initially four patients underwent operation via a sublabial transseptal approach using a rigid endoscope in conjunction with an operating microscope. The 48 subsequent operations were performed through a nostril using only rigid endoscopes. Forty-four patients had pituitary adenomas and six had various other lesions. Thirteen patients had microadenomas, 16 had intrasellar macroadenomas, nine had macroadenomas with suprasellar extension, and six had invasive macroadenomas involving the cavernous sinus. Among eight patients with Cushing's disease, seven were cured. Of 17 patients with prolactinomas, 10 were cured clinically and chemically. Among 19 patients with nonsecreting adenomas, 16 underwent total resection and three subtotal resection, with residual tumor in the cavernous sinus. Postoperatively all patients who had undergone endonasal endoscopic surgery had unobstructed nasal airways with minimal discomfort. More than half of the patients required only an overnight hospitalization.

안근 마비를 동반한 접형동 점액낭종

Mucocele is chronic, expansile cyst-like lesions of the paranasal sinus. Mucocele of sphenoid sinus is rare. The first description of a sphenoid mucocele was by John Berg in 1889. Seventy to eighty cases reported in the literature. In the Korean literature, 8 to 10 cases reported including visulal loss. As the mucocele enlarges, there is pressure resorption of the surrounding bone, exposing and stretching of the dura with pain, and involvement of contigious vital structures. We have recently experienced a case of sphenoid sinus mucocele which presented with ophthalmoplegia. This case was treated by sphenoidotomy using modified sublabial transseptal approach.

Management of a large sphenoethmoid mucocele with intracranial extension

This article describes the benefits of combining nasal endoscopy with a sublabial, transseptal approach to the sphenoid and roof of the nasal vault, in the management of a large sphenoethmoid mucocele with intracranial extension. A single case is reviewed, describing the pre- and postoperative imaging of the patient, as well as a description of the operative approach. We conclude, based on this case and review of similar cases in the literature, that large sphenoethmoid mucoceles with intracranial extension may be managed with 0° and 25° nasal endoscopes combined with a sublabial transseptal approach by performing an adequate marsupialization, at least as an initial approach. This article describes the benefits of combining nasal endoscopy with a sublabial, transseptal approach to the sphenoid and roof of the nasal vault, in the management of a large sphenoethmoid mucocele with intracranial extension. A single case is reviewed, describing the pre- and postoperative imaging of the patient, as well as a description of the operative approach. We conclude, based on this case and review of similar cases in the literature, that large sphenoethmoid mucoceles with intracranial extension may be managed with 0° and 25° nasal endoscopes combined with a sublabial transseptal approach by performing an adequate marsupialization, at least as an initial approach.

Sublabial transseptal repair of choanal atresia or stenosis.

Bilateral choanal atresia in newborns and infants carries significant morbidity and mortality, therefore, prompt correction is required. The transnasal route is usually preferred in the infant age group. This approach, however, carries significant incidence of restenosis. The transpalatal correction of choanal atresia has been the definitive approach in older children and adults. We are introducing a new procedure for correction of choanal atresia or stenosis that can be used at any age. The sublabial transseptal repair was performed in four infants without complications or restenosis. Two of our patients previously underwent different types of repair with persistent choanal stenosis. The sublabial transseptal approach provides wide exposure to the nasal cavity and the floor leading to the choanae. The operating microscope and various otologic micro-instruments were used in the surgical dissection. Preservation of the anterior inferior cartilaginous septum and the maxillary crest and spine is mandatory in order not to disturb the nasal growth pattern of the nose and premaxilla. The infants were evaluated with a computed tomography (CT) scan, preoperatively. The posterior inferior portion of the vomer is uniformly wide, increasing the degree of stenosis or atresia. Removal of the vomer is an essential part of this procedure in order to open and enlarge the choanae. Both choanae were stented with polyvinyl tubes. Every attempt was made to keep the stents in position for a minimum of 8 to 10 weeks. Follow-up has been for 2 to 4 years, and no recurrent choanal stenosis has been experienced.

Surgical Anatomy of the Parasellar Region and the Sublabial Trans-septal Approach to the Sella

Surgical Anatomy of the Parasellar Region and the Sublabial Trans-septal Approach to the Sella

The transseptal approach to lesions of the pituitary and parasellar regions

In a series of 505 consecutive procedures, the transseptal-transsphenoidal pituitary operation has proved safe and effective. The overall mortality in this series is 1.39%. A wide variety of sphenoid and sellar lesions and nearly every pituitary adenoma have been found suitable for the exposure provided through the sublabial-transseptal approach. This statement rests on the premise that both the rhinologist's and the neurosurgeon's skills are optimally applied to each case. The role of the otorhinolaryngologist is defined in this paper, and the benefits of the team approach are explored. An interpretive history of the transsphenoidal approach is presented, and the evolution of the transseptal technique developed at the Mayo Clinic from 1972 to 1978 is reviewed. Emphasizing the rhinologic aspects, all details of the surgical technique are described and illustrated. Our experience with the special endocrine syndromes is also reviewed to spotlight clinical features that require individual consideration by the rhinologic surgeon.