Hemi-transseptal Approach for Pituitary Surgery: A Follow-Up Study

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ObjectivesThe hemi-transseptal (Hemi-T) approach was developed to overcome the potential drawbacks of the nasoseptal flap (NSF) in endoscopic endonasal transsphenoidal skull base surgery. In this study, we describe further refinements on the Hemi-T approach, and report long-term outcomes as compared with traditional methods of skull base reconstruction.DesignA retrospective case-control study.SettingMontreal Neurological Institute and Jewish General Hospital, Montreal, Canada.ParticipantsPatients who underwent endoscopic endonasal transsphenoidal approach to skull base pathology.Main Outcome MeasuresOperative time, CSF rhinorrhea, and postoperative nasal morbidity.ResultsA total of 105 patients underwent the Hemi-T approach versus 40 controls. Operative time was shorter using the Hemi-T technique (180.51 ± 56.9 vs. 202.9 ± 62 minutes; p = 0.048). The rates of nasal morbidity (septal perforation [5/102 vs. 6/37; p = 0.029] and mucosal adhesion [11/102 vs. 10/39 p = 0.027]), fascia lata harvest (21/100 vs. 18/39; p = 0.0028), and postoperative CSF leak rates (7/100 vs. 9/38; p = 0.006) were lower in the Hemi-T group.ConclusionAdvantages of the Hemi-T approach over traditional exposure techniques include preservation of the nasal vascular pedicle, shorter operative time, reduced fascia lata harvest rates, and decreased nasal morbidity.

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