Article
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
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Authors
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M. Petrick
- Neurochirurgische Universitätsklinik Freiburg
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J. Honegger
- Neurochirurgische Universitätsklinik Tübingen
| Published: | May 4, 2005 |
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Outline
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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.
