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J Neurol Surg B Skull Base 2017; 78(02): 145-151
DOI: 10.1055/s-0036-1593816
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Hemi-transseptal Approach for Pituitary Surgery: A Follow-Up Study

Naif Fnais
1   Department of Otolaryngology—Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
2   Department of Otolaryngology—Head and Neck Surgery, McGill University Health Centre, Montreal, Canada
,
Salvatore Di Maio
3   Division of Neurosurgery, McGill University, Montreal, Canada
,
Susan Edionwe
*   This author is currently working as Allergy and ENT Associate in Sugar Land, Texas, United States
,
Anthony Zeitouni
2   Department of Otolaryngology—Head and Neck Surgery, McGill University Health Centre, Montreal, Canada
,
Denis Sirhan
4   Department of Cerebrovascular and Skull Base Surgery, Montreal Neurological Institute, McGill University, Montreal, Canada
,
Constanza J. Valdes
5   Department of Otolaryngology—Head and Neck Surgery, Universidad de Chile, Santiago, Chile
,
Marc A. Tewfik
2   Department of Otolaryngology—Head and Neck Surgery, McGill University Health Centre, Montreal, Canada
› Author Affiliations
Further Information

Publication History

15 June 2016

13 September 2016

Publication Date:
08 November 2016 (online)

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Abstract

Objectives The hemi-transseptal (Hemi-T) approach was developed to overcome the potential drawbacks of the nasoseptal flap (NSF) in endoscopic endonasal transsphenoidal skull base surgery. 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.

Design A retrospective case-control study.

Setting Montreal Neurological Institute and Jewish General Hospital, Montreal, Canada.

Participants Patients who underwent endoscopic endonasal transsphenoidal approach to skull base pathology.

Main Outcome Measures Operative time, CSF rhinorrhea, and postoperative nasal morbidity.

Results A total of 105 patients underwent the Hemi-T approach versus 40 controls. Operative time was shorter using the Hemi-T technique (180.51 ± 56.9 vs. 202.9 ± 62 minutes; p = 0.048). The rates of nasal morbidity (septal perforation [5/102 vs. 6/37; p = 0.029] and mucosal adhesion [11/102 vs. 10/39 p = 0.027]), fascia lata harvest (21/100 vs. 18/39; p = 0.0028), and postoperative CSF leak rates (7/100 vs. 9/38; p = 0.006) were lower in the Hemi-T group.

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

Keywords

skull base - pituitary surgery - endoscopic endonasal - nasoseptal flap

Note

Presented at the 26th Annual Meeting North American Skull Base Society, Princess Scottsdale, Arizona, February 12 to 14, 2016.


Letter to this article:

Hemi-transseptal versus Combined Transseptal/Transnasal Approach to the Sellar Region: Differences in Incidence of Postoperative CSF Leak RateJ Neurol Surg B Skull Base 2019; 80(03): 330-331
DOI: 10.1055/s-0037-1620247

 

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