Approaches to the sellar and parasellar region: a retrospective comparison of the endonasal-transsphenoidal and sublabial-transsphenoidal approaches

Tumors of the hypophysis are often managed surgically by the neurosurgeon and the otolaryngologist. Three widely used anterior routes to the sella are the endonasal (transcolumellar) transsphenoidal, sublabial transsphenoidal, and transethmoidal approaches. We reviewed the charts of 60 patients who underwent surgery, 42 transcolumellar and 18 sublabial, for sellar and parasellar adenomas and compared the two transsphenoidal approaches. None of the patients in our study underwent the transethmoidal approach. Furthermore, 26 of the patients underwent an extensive interview to assess postoperative progress. Clinically, neither approach had any significant complications, and none of the patients in either group reported significant postoperative morbidity. On the basis of these results, we believe there is minimal difference in patient subjective reports and objective morbidity when comparing the sublabial and transcolumellar approaches.

Approaches to the sellar and parasellar region: anatomic comparison of the microscope versus endoscope

OBJECTIVE

Traditionally, surgical approaches to the sellar region require the use of the operating microscope. Over the past decade endoscopic surgery has gained much popularity because of advances in optics and illumination. Endoscopic surgery of the sellar region has been performed successfully. The goal of the present study was to quantify the amount of exposure to the sellar and suprasellar region that the endoscope provides versus the microscope, with three different anterior approaches to the sellar region.

METHODS

The transethmoidal, endonasal-transsphenoidal, and sublabial-transsphenoidal approaches were performed on 14 formalin-fixed cadaver heads with a 0 degrees endoscope and repeated with the operative microscope. The distances of relevant surgical landmarks and the amount of exposure superior and anterior to the dorsum sella, as well as the lateral exposure, were measured. The mean distances were then used to calculate the volume of exposure for each of the approaches.

RESULTS

It was found that the endoscope provided greater view than the operating microscope in all three approaches. The difference was statistically significant using a paired Student t test and a signed-rank test (P<.001).

CONCLUSION

The authors believe that endoscopic surgery of the sellar region can be performed safely and effectively, while providing the surgeon with a view that is superior to that afforded by the operating microscope.

Thyroglossal duct cyst: the New York Eye and Ear Infirmary experience and a literature review

Thyroglossal duct cysts often present in childhood but can also afflict the adult population. In 1920, Sistrunk described surgical management and advocated the removal of the central portion of the hyoid bone, following the cyst tract to the base of the tongue. This surgical technique has not changed since its description 60 years ago. In this paper, a retrospective review of 70 thyroglossal duct cyst excisions performed at the New York Eye and Ear Infirmary from 1988 through 1996 is presented. The patient population consisted of 43 females (61%) and 27 males (39%). The average age at presentation was 21.5 years, with a range of 18 months to 64 years. The most frequent presenting symptoms was a painless midline neck mass. Computed tomography (CT) was the most frequent imaging study performed. Sixty-four patients underwent a Sistrunk procedure while five patients had excision alone. One patient was diagnosed but lost to follow-up. All five patients who underwent simple cystectomy required a second procedure. One patient who underwent the Sistrunk operation required revision. Nine patients had postoperative complications, with recurrence being the most common. We present our experience over an eight-year period.