gms | German Medical Science

Objective: The purpose of this study was to evaluate the effect of posterior septectomy size on surgical exposure and surgical freedom during the endoscopic transsphenoidal approach to the sellar and parasellar region.

Methods: A mononostril and binostril approach to sellar region was performed on 4 formalin-fixed cadaveric heads. Predefined anatomical structures were identified. Additionally, a millimeter gauge was introduced into the approach and the extent of dorsal septectomy was analyzed in binostril approach in comparison to mononostril approach. Surgical freedom was defined as the distance between the ipsilateral and contralateral limit of opening of sphenoid sinus.

Results: The mean extend of dorsal septectomy was 15.7?±? 5.7 mm using a binostril approach to achieve adequate visualization of all relevant anatomical structures. There was no significant correlation between the distance of the surgical corridor and the extend of dorsal septectomy in the analysis (p=0.41).

Superior results were obtained via binostril technique with respect to ability to identify contralateral ICA or OC recessus. No such advantage was found for all other landmarks.

Surgical freedom between the ipsilateral and contralateral limit of exposure of the sphenoid sinus was measured with 15 ± 0.8mm in the mononostril and 19.2 ± 0.9mm in the binostril group.

Conclusion: The surgical exposure increased significantly with progressively larger posterior septectomy in binostril approaches until a 20-mm posterior septectomy. Bilateral lateral opticocarotid recesses were accessible with a mean of 15mm for posterior septectomy. In mononostril group no dorsal septectomy was necessary. Thus, the nasal mucosa is more preserved by this technique. However, the lateral exposure is partially limited and the use of angled endoscopes is recommended adopting a mononostril approach to sellar region.