Transnasal and Transethmoidal Approaches to the Sella Turcica

K. J. Lee and Nilesh R. Vasan

The transseptal transsphenoidal approach to the pituitary is the most common method used by otolaryngologists for access to the pituitary gland. The procedure requires a two-team approach, with the otolaryngologist providing access for the neurosurgeon to remove lesions within the sella turcica.

• Magnetic resonance imaging (MRI) to assess the lesion within the sella and brain
  
• Computed tomography (CT) scan to determine the anatomy within the nasal cavity, paranasal sinuses, and skull base. Information regarding access to the sphenoid sinus is provided by fine-cut coronal CT images.

• A grossly deviated septum, previous surgery, or nasal polyposis can complicate the operation, and other surgical approaches to the sphenoid may need to be considered (e.g., transethmoidal approach). Alternatively, procedures to correct these abnormalities may be required.
  
• Any bleeding disorder must be correctly diagnosed and managed prior to the operation. Excellent hemostasis is vital to perform this operation safely.