gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

The direct pernasal approach as the procedure of choice to the sella turcica: Experiences with 150 cases

Der direkt pernasale Zugang als das Vorgehen der ersten Wahl zur Sella tucica: Erfahrungen mit 150 Fällen

Meeting Abstract

Suche in Medline nach

  • corresponding author M. Petrick - Neurochirurgische Universitätsklinik Freiburg
  • J. Honegger - Neurochirurgische Universitätsklinik Tübingen

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc09.05.-08.01

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0026.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Petrick et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Multiple surgical approaches to the sphenoid sinus and the sella turcica have been described. The sublabial-transseptal approach and the pernasal-transseptal approach have been classically used to gain access to the sphenoid sinus and the pituitary fossa. The direct pernasal approach, which is also called transnasal septal displacement procedure or „septal pushover“, has only recently been recognized as a minimally-invasive variant in transsphenoidal surgery.

Methods

We describe and illustrate our surgical technique of the direct pernasal approach. The operation times of the pernasal procedure are compared to those of transseptal procedure. Furthermore, the patients immediate and delayed postoperative complaints are described.

Results

The direct pernasal approach provides for speedy exposure of the sphenoid. The total operation time is reduced by 25 minutes as compared to the classical transseptal procedures. The direct pernasal approach is extremely well tolerated. The patients have less pain and especially less ventilation problems of the nasal sinuses. It is important to carefully realign the nasal septum and readjust the middle turbinates before closure. In less than 5% of the patients, the surgical strategy was changed intraoperatively and a transseptal approach was used because of an extremely narrow space between the turbinates and the bony nasal septum.

Conclusions

The direct pernasal approach is a fast and minimally-invasive procedure which is extremely well-tolerated by the patients. For us, it is the approach of first choice in transsphenoidal surgery.