In neurosurgery, the brain is treated, so the surgical approach through the sphenoid sinus of the nose is vividly called the nasal sphenoidal approach.
The nasal sphenoidal approach is definitely a minimally invasive surgery. Like other minimally invasive surgeries in neurosurgery, it uses a small opening leading to the inside of the skull.
Minimally invasive surgery has its limitations, which we have already discussed in the last surgical case of removing parasites. After the surgical instruments are inserted through the small incision, theoretically speaking, this opening will form a roughly conical extreme surgery.
Area. Beyond the limit area, instruments cannot reach and surgery cannot be performed.
For nasal sphenoidal approach surgery, the central area of the best surgical area is the central area where the sphenoid sinus enters. Let’s mention the sella turcica area we mentioned at the beginning again.
The surgical area that can be treated by rhinosphenoidal surgery basically revolves around the sellar area. In addition to the sellar area, some lesions in the suprasellar area, parasellar area, slope area, etc. near the sellar area, the doctor can see as much as possible with the rhinoscope.
Assist patients with surgical procedures.
Performing surgery through the nose, without the need for a craniotomy, or even drilling a hole, and without leaving any scars, sounds like it is definitely a better surgical approach than minimally invasive surgery through drilling. Patients must like this kind of surgery the most.
Not only the patients, but the doctors also like it.
What I like is not the trouble of not opening the hole, but if you don’t go through the nose, if the doctor wants to open the patient’s skull for surgery, he can only start from the top and both sides of the head. These surgical approaches are not without exception, and the paths experienced
It is longer, needs to pass through a lot of brain tissue, and cannot bypass the important area of the eye.
As we have said before in neurosurgery, we are most afraid of inadvertently injuring other normal brain tissues and nerve blood vessels during the operation. Detouring as much as possible is the best surgical method. Therefore, three-dimensional positioning of neurosurgery has been repeatedly mentioned as the most important point.
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Look at it this way, a patient who wants to undergo nasal sphenoidal surgery wants to have a doctor, but whether it can be done depends on the patient's condition and the patient's luck. It depends on whether the tumor can grow just enough so that the surgical instruments can be reached under the doctor's nose.
The most appropriate tumor to grow in this place is a pituitary adenoma, because the pituitary gland is located in the sella turcica area. The best indication for nasal sphenoidal surgery is a regular and long pituitary adenoma.
Another type of tumor that is more appropriate is craniopharyngioma. The craniopharynx duct is a structure that connects the adenohypophysis and the pharyngeal duct and later degenerates and disappears. Therefore, most of the tumors that grow here are benign tumors caused by congenital factors. They are related to the pituitary gland.
, is naturally an operation that can be performed on the pituitary gland. As long as it is in a suitable location, it can also be performed through the transnasal sphenoidal approach.
Since the surgical area of the transsphenoidal approach is too limited, if the tumor happens to grow just a little beyond the surgical area, what should I do if I want to continue using the transsphenoidal approach? Is there a more flexible way to solve it?
In surgery, it is common to encounter situations where the surgical field is just a little smaller after being entered. As we have said in countless previous cases, the simplest and most effective way to expand the surgical field is to expand the incision.
The same principle applies to the nasal sphenoidal approach. To widen the sphenoid sinus is called extended sphenoid sinus incision, and the sphenoid mucosa and part of the posterior ethmoid sinus are removed.
At this point in the conversation with the patient, the people in Fangze in the next room could finally hear Dr. Tong's voice, and the people in the association pricked up their ears to listen.
