Endoscopic endonasal hemisphenoidotomy for resection of pituitary lesions confined to the sella: report of 3 cases and technical note.

The authors report use of a minimally invasive endoscopic procedure, unilateral endonasal hemisphenoidotomy, for removal of lesions contained in the sella. The entire procedure was performed through a single nostril with the use of an endoscope. A unilateral endonasal hemisphenoidotomy (1.5 cm x 1.5 cm) was performed and was sufficient to expose the sellar floor for successful removal of adenomas confined to the sella in three patients. Neither outfracturing the midline septum nor exposure of the opposite sphenoid ostium was necessary for adequate visualization, tumor exposure, or instrument maneuverability. There was, however, a learning curve required in order to become facile and efficient with the equipment. All lesions were completely resected. When compared to a bilateral endoscopic endonasal sphenoidotomy as practiced by us, the operative time was reduced and the length of stay was 1-2 days. There was less operative trauma, patients appeared to experience less pain immediately postoperatively, and their satisfaction was very high. In conclusion, for resection of this group of intrasellar tumors, the hemisphenoidotomy procedure proved to be less invasive and traumatic, more simple, and faster than the standard bilateral endoscopic sphenoidotomy.