Hemi-transseptal Approach for Pituitary Surgery: Long Term Follow-up Study

Background: The rate of cerebrospinal fluid (CSF) leaks following endoscopic endonasal approaches to the skull base has reduced dramatically with implementation of the naso-septal flap (NSF), however at the potential cost of increased operative time and post-operative nasal morbidity. To overcome these potential drawbacks, the hemi-transeptal (Hemi-T) approach was developed. In this study we describe further refinements on the Hemi-T approach, and report long term outcomes as compared with traditional methods of skull base reconstruction.

Methods: A retrospective case-control study was conducted between July 2010 and April 2015 comparing the Hemi-T approach with previously used methods of skull base exposure and reconstruction. Outcome measures included operative time, CSF rhinorrhea, and post-operative nasal morbidity.

Results: A total of 98 patients underwent the Hemi-T approach versus 37 controls. Operative time was shorter using the Hemi-T technique (180.51 ± 56.9 minutes versus 202.9 ± 62; p = 0.048). The rates of nasal morbidity (septal perforation [3/92 versus 5/37; p = 0.029] and mucosal adhesion [9/98 versus 8/37 p = 0.012]) and facia lata harvest (8/98 versus 14/37; p = 0) were lower in the Hemi-T group. There was no difference in intra- or post-operative CSF leak rates.

Conclusion: Advantages of the Hemi-T approach over traditional exposure techniques include preservation of the nasal vascular pedicle, shorter operative time, reduced facia lata harvest rates, and decreased nasal morbidity.