In neurosurgery, the brain is treated, and the surgical route through the sphenoid sinus is figuratively called the nasal sphenoidal approach.
The transsphenoidal approach is definitely a minimally invasive surgery. Like other minimally invasive neurosurgery surgeries, it uses a small opening leading to the inside of the brain.
Minimally invasive surgery has its limitations, which we have already discussed in the last case of parasite removal surgery. Theoretically, after the surgical instruments enter through the small incision, a roughly conical extreme surgical area will be formed with this opening. Beyond the extreme area, the instruments cannot reach and surgery cannot be performed.
For nasal sphenoidal approach surgery, the best central area for surgery is the central area where the sphenoid sinus enters, which again refers to the sella turcica area we mentioned at the beginning.
The surgical area that can be treated by the nasal butterfly surgery is basically around the sella turcica. In addition to the sella turcica, the lesions in the suprasellar area, parasellar area, and slope area near the sella turcica can be seen by the doctor with the nasal endoscope and he will try his best to help the patient with the surgery.
Performing surgery through the nose, without opening the skull or making a hole, and leaving no scars, sounds like a better surgical approach than minimally invasive surgery with a hole. Patients will definitely like this type of surgery the most.
Not to mention the patients, the doctors like it too.
What I like is not the trouble of opening a hole or not, but if the doctor does not go through the nose, he can only open the patient's skull from both sides of the top of the head to perform surgery. These surgical approaches are not without exception, and the path is long, passing through more brain tissue, and cannot bypass the important area of the eyes.
We have said before that the most fearful thing about neurosurgery is inadvertently damaging other normal brain tissues and nerves and blood vessels during surgery. The best surgical method is to bypass it if possible. Therefore, three-dimensional positioning in neurosurgery has been repeatedly mentioned as the most important point.
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From this perspective, whether the patient wants to have a nose butterfly surgery and the doctor wants to do it depends on the patient's condition and luck. See if the tumor can grow to a size that the surgical instrument can reach under the doctor's nose.
The most suitable tumor to grow in this place is probably a pituitary adenoma, because the pituitary gland is located in the sella turcica. The best indication for nose-sphenoid surgery is a well-proportioned pituitary adenoma.
Another type of tumor that is more appropriate is craniopharyngioma. The craniopharyngioma is a structure that connects the adenohypophysis and the pharyngeal duct, which later degenerated and disappeared. Therefore, most tumors that grow here are benign tumors caused by congenital factors. Since it is related to the pituitary gland, it is naturally an operation that can be performed on the pituitary gland. As long as it grows in a suitable location, it can also be performed through the transsphenoidal approach.
Since the surgical area of the transsphenoidal approach is too limited, if the tumor happens to grow only slightly beyond this surgical area and we really want to continue with the transsphenoidal approach, what can we do? Is there a more flexible way to solve this problem?
In surgical operations, it is common to encounter situations where the surgical field is found to be a little smaller after entering. We have mentioned in countless previous cases that the most effective way to expand the surgical field is to enlarge the incision.
The same principle applies to nasal sphenoidal approach surgery. The sphenoid sinus is widened, which is called extended sphenoid sinusotomy, and the sphenoid mucosa and part of the posterior ethmoid sinus are removed.
When the conversation with the patient reached this point, Fang Ze and his family in the next room could finally hear the voice of Doctor Tong, and they and the people from the National Association pricked up their ears to listen.
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