The minimally invasive surgical procedure for pituitary tumors is roughly as follows: the nasal cavity on one side of the nasal spreader is guided by a microscope or endoscopic light source to reach the pterygoid sinus and saddle base below the pituitary gland, and then the pituitary lesion is removed. The whole procedure is completed through a nasal opening of less than 3cm x 3cm, with no incision on the head and face, less trauma, shorter operation time and faster postoperative recovery. At present, transsphenoidal minimally invasive surgery is a mainstream surgery for pituitary tumor treatment, and there are three main surgical approaches as follows
Microscopic transsphenoidal surgery: Illumination is provided by a microscope, the anterior wall of the pterygoid sinus is reached through a nasal spreader, the posterior segment of the nasal septum is propped and squeezed to the opposite side, and then the pterygoid sinus is opened to expose the tumor. This procedure allows the operator to operate with both hands, which is in accordance with the conventional surgical habits, but will certain degree of destruction of the original bone of the butterfly and nasal septum. Due to the limitation of illumination, there is a certain blind area in the saddle, and some of the tumor may remain when some surgeons with less surgical experience operate.
Neuroendoscopic transsphenoidal surgery: This procedure is a minimally invasive pituitary adenoma resection technique that has been carried out and rapidly promoted at home and abroad in the past 20 years, and the procedure is roughly the same as the previous microscopic surgery, with obvious advantages.
The main advantages are as follows: 1. It reduces the damage to the mucous membrane at the bottom of the nasal cavity and the upper part of the nasal septum, and septal perforation rarely occurs after surgery; 2. It does not cause bony septal fracture and does not affect the postoperative nasal shape; 3. and quick recovery.
However, endoscopy also has its disadvantages, endoscopy is to display the three-dimensional structure through the screen in a flat image, which lacks the sense of three-dimensional hierarchy and requires high operator proficiency, and the operating space is more narrow compared to microscopic surgery, and special training is required for surgical operation.
Neuroendoscopy combined with microscopic transsphenoidal surgery: the combination of the two can bring out the advantages of both and avoid the shortcomings. This procedure is the most ideal procedure to remove pituitary tumor through the nasal butterfly approach.