Tailored Selection of Nostril in Microscopic Endonasal Transphenoidal Approach for Pituitary Adenomas

초록

Purpose: Transsphenoidal approach (TSA) has been traditionally done through right nostril or right submucosal space with the surgeon sitting on the right side of patient. The trajectory and angle of view obtained with the microscopic endonasal TSA are slightly off the midline and thus provide better visibility of the side contralateral to the approached nostril. We tailored selection of the nostril according to the laterality of pituitary adenoma (PA) to increase the visibility of lasteral margin of tumor. Material and Method: Twenty eight macroadenomas operated by microscopic endonasal TSA with the intention of total resection were included in this study. Eighteen cases were nonfunctioning Pas and 10 were functioning Pas. Eight cases were invasive Pas. In Pas with laterality, we used the nostril contralateral to the side of laterality. Right nostril was used for bilaterally symmetric Pas. If the tumor margin ipsilateral to the approached nostril could not be visualized adequately, the other nostril was used as well. Results: Right, left and both nostrils were used in 10, 10 and 8 cases, respectively. Total resection could be done in 27 cases but I growth hormone secreting PA with invasion into the right cavernous sinus. The lateral margin of the tumor contralateral to the initially selected nostril could be visualized completely in 25 cases and almost completely in 3 cases. Poor visibility of the lasteral margin of the tumor ipsilateral to the initially selected nostril necessitated additional use of the other nostril in 8 cases. Conclusion: Tailored selection of the nostril according to the laterality of tumor in microscopic endonasal TSA may increase the chance of total resection by improving visibility of lateral margins of tumor.