Novel Approach to the Sphenoid Sinus

Abstract

Objective

Transnasal approaches to the pituitary and beyond are increasingly being utilized. Surgical access to the sphenoid sinus is the first step in any of these approaches. In order to allow a binostril approach, the posterior septum is removed, resulting in a large posterior septal perforation. Another consideration in many cases is harvesting material for repair of any cerebrospinal fluid (CSF) leak. We describe a novel endoscopic transseptal approach using a posterior nasal septal mucosal flap that allows a binostril approach for the surgeons, can cover skull base defects, and avoids posterior nasal septal perforations.

Methods

Retrospective chart review of endoscopic pituitary surgery patients, in a tertiary referral center between 2006 and 2008, was performed. Relevant post-operative complications of CSF leak, epistaxis, crusting, synechiae and septal perforation were documented.

Results

20 consecutive patients undergoing pituitary surgery were reviewed: 12 males and 8 females aged 24 to 76 years old. No early perioperative complications were encountered. Surgical time was not increased. Two minor postoperative complications: 1 epistaxis and 1 partial flap retraction were noted. There were no CSF leaks and no septal perforations.

Conclusions

The approach has the advantage of allowing two surgeons to manipulate surgical instruments and a more robust pedicled flap is raised to assist the closure of a skull base defect. The nasal septal mucosa from one side is preserved, avoiding a nasal septal perforation. There is minimal additional morbidity.