Increasingly, the otolaryngologist is called on to provide exposure for the neurosurgeon performing transsphenoidal hypophysectomy. The 3 most common approaches for this exposure are the transnasal transseptal, sublabial transseptal, and external rhinoplasty approaches. We reviewed our series of 135 patients undergoing transnasal hypophysectomy for postoperative complications. In our series, we found that 18% of patients had a postoperative septal perforation, 2% of which were symptomatic; 6% of patients reported nasal cosmetic deformity; 13% reported transient lip numbness; and 3% reported postoperative nasal dysfunction. When comparing our complication rate with those published for the sublabial and external rhinoplasty approaches, we found the transnasal approach provides excellent exposure with less dissection and fewer postoperative complications. On the basis of these results, we believe that the transnasal transseptal approach provides excellent exposure for transsphenoidal hypophysectomy in all patients who require pituitary surgery.
When exposing the horizontal petrous carotid artery in preparation for intrapetrous carotid bypass, the surgeon has no definite landmarks to localize the perimeter of the cochlea. The results of this study provide a practical, consistent, and safe method to maximize carotid artery exposure while minimizing cochlear injury. We measured the carotid-cochlea distance (mean, 4.3 mm) and the carotid-cochlear angle (mean, 10.8 degrees) in 33 temporal bones in which the extended middle fossa approach had been performed. We correlated this distance to the width of a Sheehy weapon knife, which can be easily measured intraoperatively. Twenty-five temporal bones were imaged prior to surgical exposure using a new computed tomography (CT) protocol that can be used for preoperative assessment of the carotid-cochlear anatomy. The carotid-cochlea distance and carotid-cochlear angle measured on CT are compared with postsurgical measurements.
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