ABSTRACT
The sub-labial transsphenoidal approach is frequently used in pituitary surgery. The direct transnasal transsphenoidal route is a minimally invasive technique. The main difficulty associated in this approach is its tendency to take an oblique trajectory, so it can benefit from the combination of use of the microscope and the endoscope. We have analysed the data of the first 10 patients operated on through the direct transnasal route for pituitary adenomas in our institution. The operating procedure was done in 2 steps: 1. Direct transnasal approach to the sphenoid sinus to reach the floor of the sella turcica with the endoscope for trajectory guidance 2. Effraction of the sella turcica floor, opening of the dura mater and adenoma excision under the operating microscope We have analysed the feasibility, endoscopic benefits and effectiveness of this procedure. Ten patients were operated having pituitary adenomas between March 2003 and September 2004. The endoscope is introduced through the right nostril to reach the sphenoid sinus. We did not resort to fluoroscopy. Adenoma exeresis was made under microscope and was complete in 8 cases. Complications such as transient CSF leakage and epistaxis were observed in one case. The initial use of the endoscope permits rapid and direct access to the sella turcica. Relay by the operating microscope allows ease of tumoural exeresis. Moreover, this approach avoids the traditional drawbacks of the sub-labial route