Anatomical landmarks in endoscopic transsphenoidale pituitary surgery.

Nowadays, Endoscopic transsphenoidal approach is accepted as the standard method for pituitary adenomas. Endoscope presents two-dimensional panoramic view of surgical field. The orientation of the surgical field becomes easier by the effective use of endoscope in short time and finding anatomic landmarks. Anatomic landmarks are the most important anatomic formations that surgeon has to find to form safe surgical field. Endoscopic Transsphenoidal Pituitary Surgery is carried out in four stages including preoperative preparation, nasal stage, sphenoidal stage and sellar stage. Superior-middle-inferior nasal conchas and sphenoid ostium are landmarks of nasal stage. By going forward through the inferior line of Concha Nasalis, concha nasalis media is leaned to lateral and by doing this concha nasalis superior becomes visible. Concha nasalis superior is approximately 1,5 cm above choanae and ostium sphenoidale with 1-2 mm diameter is just at the bottom of concha nasalis superior. Sphenovomerine suture is used for passing from nasal stage to sphenoidal stage. When sphenovomerine suture is removed, sellae base becomes clearly visible. Then, the sellae base becomes a surgical field with carotid prominence at the laterals and field from planum sphenoidale to clivus. Tumor is removed by preserving neurovascular structures. After the tumor is removed, it is checked whether there is CSF leak or not. If there is no leak, sellar reconstruction is unnecessary. If dura mater is preserved, it is re-placed and surgical field is covered with surgicel-spongostan. Preserved part of sinus mucosa is laid on surgical field and then the operation is finished. [ABSTRACT FROM AUTHOR]