Clinical Usefulness of Trasseptal Transsphenoidal Approach for Pituitary Tumors with Septal Cartilage Removal and Replacement via Modified Killian Incision: Review of 42 Cases

So Yean Kim; Byoung Wook Yang; Yong Woo Lee; Kyung Chul Lee

doi:10.18787/jr.2019.26.1.26

Journal List > J Rhinol > v.26(1) > 1126731

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Kim, Yang, Lee, and Lee: Clinical Usefulness of Trasseptal Transsphenoidal Approach for Pituitary Tumors with Septal Cartilage Removal and Replacement via Modified Killian Incision: Review of 42 Cases

Original Article

Journal of Rhinology 2019; 26(1): 26-31.

Published online: 31 May 2019

DOI: https://doi.org/10.18787/jr.2019.26.1.26

Clinical Usefulness of Trasseptal Transsphenoidal Approach for Pituitary Tumors with Septal Cartilage Removal and Replacement via Modified Killian Incision: Review of 42 Cases

So Yean Kim, MD, Byoung Wook Yang, MD, Yong Woo Lee, MD, Kyung Chul Lee, MD

Department of Otolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author (fess0101@hanmail.net)

Received 5 August 2016 Revised 11 June 2018 Accepted 25 August 2018

Journal of Rhinology

Abstract

Background and Objectives

The conventional transseptal transsphenoidal approach can inhibit visualization of the surgical field and may change the shape of external nose. We used the transseptal transsphenoidal technique to remove septal cartilage except the L strut via a modified Killian's incision and preserved the ‘key-stone area.’ The aim of this study was to verify the usefulness of this technique.

Subjects and Method

Retrospective analysis was carried out on 42 pituitary tumor patients who received this technique by a single otolaryngologist from March 2005 to March 2012 at Kangbuk Samsung Hospital.

Results

The mean patient age at time of surgery was 52 years, and 41 cases were pituitary adenoma and 1 was Rathke's cleft cyst. Three patients had undergone prior surgery; of which 2 used a pterional approach and 1 a transsphenoidal approach. With regard to complication, there were 2 cases of CSF leakage and 5 cases of septal laceration. There were no cases of meningitis, deformity of external nose, septal perforation, anosmia, or sinusitis. In post operation follow up, 25 cases (59.5%) had no residual tumor, while 17 cases (40.5%) had residual tumor.

Conclusion

This study reveals that transseptal transsphenoidal surgery with septal cartilage removal and a replacement technique for a pituitary tumor are effective, allow easy exposure, and result in a low complication rate.

Keywords: Transsphenoidal approach, Pituitary adenoma, Killian incision

Figures and Tables

Fig. 1

Diagrammatic representation of trasseptal transsphenoidal approach with septal cartilage removal and replacement via modified Killian incision. White line: L -strut, Grey zone: area of cartilage harvest and reposition (A). Removal of septal cartilage conserving L-strut (B).

Fig. 2

Diagrammatic representation of endoscopic transnasal approach. Nasal speculum used to fracture the posterior bone of nasal septum to reach anterior wall of sphenoid sinus (A). Opening speculum fully makes the nasal septum be dislocated unilaterally. it usually results in an associated tear in the septal nasal mucosa close to the ethmoidal crest on the anterior surface of the sphenoid bone (B).

Table 1

Demographics of patients (n=42)

Table 2

Rhinologic & neurosurgical complication after trasseptal transsphenoidal approach with septal cartilage removal and replacement via modified Killian incision

Table 3

Residual tumor volume during follow up periods after trasseptal transsphenoidal approach with septal cartilage removal and replacement via modified Killian incision (n=42)

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