Transseptal approach for the treatment of pituitary lesions

J. R. Escajadillo and E. de Gortari

The transseptal approach is the most logical and adequate technique to reach the sella turcica and adjacent structures. In the era before the use of antibiotic and steroid replacement therapy, Harvey Cushing, MD, and Norman Dott, MD, obtained successful results by using the transseptal approach to resect and decompress pituitary adenomas. Some authors use the maxilla-premaxilla technique followed by a sublabial incision through which they introduce the trans-sphenoidal speculum. The endonasal approach is a modification of the sublabial incision, but much of the perpendicular plate of the ethmoid is still removed. Therefore, we have added another modification that consists in removing only a fragment of the perpendicular plate of the ethmoid and vomer anterior to the sphenoid rostrum. We also describe our experience with this technique and analyze our results.