gms | German Medical Science

Objective: Endoscopic surgical procedures have gained wide acceptance in the treatment of sellar lesions. Most surgeons use the four hands two nostrils approach. We hereby report our experiences with the unilateral (one nostril) approach for treatment of (peri)sellar lesions.

Methods: Between December 2008 and 2009 25 consecutive patients (24 adults, 1 child; 9 males) were operated via an uninostril transnasal transsphenoidal approach to treat (peri)sellar pathologies (21 pituitary adenomas, 1 recurrent myopericytoma, 1 recurrent craniopharyngeoma, 1 abscess, 1 Rathke cleft cyst). One lesion was purely intrasellar, all others had a suprasellar (24) or parasellar (7) extension. Complete pre- and postoperative neuroradiological, endocrinological and ophthalmological status was documented in a data base.

Results: In the 2 patients with recurrent lesion and 3 patients with large parasellar extension of an adenoma the subtotal removal of the tumor with decompression of the optic system was accomplished. In all other patients (20) complete removal was achieved. In the patients with the recurrent myopericytoma an accentuated diplopia due to VIth nerve palsy was encountered. 1 patient suffered from postoperative DVT, otherwise no complications occurred. All patients (12) with impaired visual acuity improved. The endocrinological status remained unchanged in 21 patients. Two patients had new endocrinological deficit (1 diabetes insipidus, 1 pituitary insufficiency). Two patients with preoperative partial pituitary insufficiency improved to normal status postoperatively.

Conclusions: The uninostril transnasal transsphenoidal approach is a minimally invasive surgical option to safely and effectively remove sellar lesions with a high patient’s comfort and good clinical and radiological results.