Endonasal Trans-sphenoidal Approach through One Nostril / 대한이비인후과학회지

ABSTRACT

BACKGROUND AND OBJECTIVES: Transseptal TSA (transsphenoidal approach) has advantages of wide exposure, good operative view, and use of two hands, but has disadvantages of external nasal scar, possibility of external nasal deformity and severe nasal pain. And endoscopic TSA can reduce nasal morbidity, but operator can't use two hands with the endoscope and it also has disadvantages of narrow operative field. Endonasal TSA is a new approach technique taking the advantages of transseptal and endoscopic TSA. SUBJECTS AND METHOD: We reviewed 112 patients who had been operated with this method from Mar, 2001 to Sep, 2003. Details of surgical technique of this approach are presented. We investigated the operative time, hospital periods, and complications. RESULTS: The mean operative time was 95 minutes. Nasal packings were removed on the first postoperative day in 106 cases, and on second postoperative days in 6 cases. The mean postoperative hospital stay was 3.2 days. During the follow-up periods (6-24 months, mean 13.5 months), there were complications of olfactory disturbance (4 cases), nasal septal deviation (2 cases), epistaxis (1 case), nasal septal perforation (1 case), CSF leakage (1 case), hypopituitarism (3 cases), and diabetes insipidus (4 cases). Meningitis, external nasal deformity, external scar, paresthesia or sinusitis were not noticed. CONCLUSION: Using endonasal TSA, we could operate easily with two hands, obtaining a good operative view and short operation time. The technique presented minimal nasal morbidity, a short hospital stay and low incidence of complications.