Early attempts to remove pituitary tumors included a transcranial approach that was impeded by numerous anatomic obstacles like the cavernous sinus, the carotid artery, and the optic chiasm. Nearly every pituitary tumor can be exposed and removed thro...
Early attempts to remove pituitary tumors included a transcranial approach that was impeded by numerous anatomic obstacles like the cavernous sinus, the carotid artery, and the optic chiasm. Nearly every pituitary tumor can be exposed and removed through the nasal septum. Advances in physics and biochemistry have supported substantial improvements in diagnosis and management so that transseptal transsphenoidal approach is one of the most predictable operations performed for pituitary tumor. The sublabial transseptal approach(Hardy) should access to the septal spaces and the sphenoid sinus, working entirely under the lip. However, working into the nose from a low angle under the canopy of the orbicularis oris muscle does restrict visibility at the point surgeon needs it most, over the premaxillar wings. In 1990, we began performing the entire septal dissection through a septal hemitransfixation incision, saving the sublabial incision until later in the operation when we wanted to insert the nasal speculum. This modified approach improved our ability to elevate the mucoperichondrium from the anterior-inferior regions of the septum in the premaxillary region without perforation. The nasal spine ceased to be an issue because it was no longer in the way. We studied 10 cases of modified transseptal transsphenoidal approach to pituitary tumor and other lesions during a period of 6 years between September. 1990 and October, 1996.