Transseptal Versus Endonasal Approaches in Endoscopic Transsphenoidal Surgery for Pituitary Tumors

Currently, transsphenoidal surgery is considered the procedure of choice for treating most sellar lesions. There are two different surgical options for performing the transsphenoidal procedure, the transseptal and the endonasal techniques. Objective: the aim of this study is to compare transseptal and endonasal approaches in endoscopic transsphenoidal surgery for pituitary tumors regarding intraoperative factors and postoperative outcome. Patients and Methods: 40 patients with pituitary adenomas operated upon in the period from 2007 till 2011 were included in the study; the patients were divided into two groups, the 1st group was operated through a transseptal approach using the endoscope and this group included 22 patients. The 2nd group was operated through a direct endonasal approach using the endoscope and this group included 18 patients. Results: Total removal was achieved in 31.8% of the transseptal group and in 33.3% of the endonasal group. Subtotal removal was achieved in 59.1% of the transseptal group and in 61.1% of the endonasal group. Partial tumor removal was achieved in 9.1% of the transseptal group and in 5.6% of the endonasal group. Conclusion: Endoscopic transseptal technique may be comparable to direct endonasal technique in endoscopic transsphenoidal surgery for pituitary tumors in terms of total tumor resection, operative time, hospital stay, intraoperative factors and postoperative morbidity, Transseptal technique is specially preferred when there is significant nasal septal deviation.