Transsphenoidal “Cross Court” Approach Using a Slightly Modified Speculum to Reach Pituitary Adenomas with Lateral Growth

Summary

¶ Background. The purpose of this study was to evaluate the usefulness of an oblique “cross court” transsphenoidal approach using a speculum with slightly modified projections for pituitary adenomas showing lateral extension.

 Method. The projection of the speculum on the side of the cavernous lesion was shortened by 5 mm. The tip of the longer projection was placed in the sphenoid sinus, while the end of the shorter projection was placed on the concha sphenoidalis. An oblique transsphenoidal view was then easily obtained by opening the speculum. The contralateral nasal incisura had to be widened in some cases to achieve a more oblique view.

 Findings. Twenty-eight patients diagnosed with pituitary adenoma showing lateral growth underwent adenomectomy under direct observation of the medial portion of the cavernous sinus using this approach. Postoperative normalization of hyperendocrinopathy or gross total removal of the tumour was achieved in the majority of patients.

 Interpretation. An oblique transsphenoidal approach using this speculum and contralateral minor maxillary osteotomy afforded a direct view of the medial cavernous sinus, sufficient for the removal of adenomas showing minor to moderate lateral growth.