How I do it: the mononostril endonasal transethmoidal-paraseptal approach
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The use of endoscopes in transnasal surgery offers increased visualization. To minimize rhinological morbidity without restriction in manipulation, we introduced the mononostril transethmoidal-paraseptal approach.
The aim of the transethmoidal-paraseptal approach is to create sufficient space within the nasal cavity, without removal of nasal turbinates and septum. Therefore, as a first step, a partial ethmoidectomy is performed. The middle and superior turbinates are then lateralized into the ethmoidal space, allowing a wide sphenoidotomy with exposure of the central skull base.
This minimally invasive transethmoidal-paraseptal approach is a feasible alternative to traumatic transnasal concepts with middle turbinate and extended septal resection.
KeywordsEndoscopy Mono-nostril Pituitary Skull-base Trans-sphenoidal
Compliance with ethical standards
Conflicts of Interest
Prof. Dr. med. R. Reisch and KD Dr. med. H. R. Briner are consultants of Karl Storz GmbH, Tuttlingen, Germany.
The video “trans-ethmoidal, paraseptal approach to the sella” illustrates the main steps of a minimally invasive, mono-nostril approach to the sella preserving the middle turbinate and the septum, yet allowing a mono-nostril bimanual resection. (MP4 299966 kb)