Endoscopic Transseptal Approach [Neurosurgery Wiki]

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====== Endoscopic Transseptal Approach ======

Kim et al. sought to examine the utility of an endoscopic [[transseptal approach]] and the creation of a bilateral [[nasoseptal flap]] using a 2-nostrils/4-hands technique in patients with challenging skull-base tumors.

Methods: The medical records of patients operated on via an endoscopic transseptal approach between 2009 and 2017 were retrospectively reviewed. Two patients with ossifying fibroma, 2 with orbital hemangioma, 2 with trigeminal nerve schwannoma, and 1 patient each with juvenile angiofibroma, meningioma, and myxofibrosarcoma were included in the study. The surgical technique and endoscopic anatomy are presented.

Results: The mean age of the 4 male and 5 female patients was 39.9 ± 14.8 years. By using this technique, all 7 tumors were resected with minimal nasal morbidity after a mean follow-up of 15.2 ± 9.4 months.

Conclusions: The endoscopic transseptal approach, by creation of a bilateral nasoseptal flap using a 2-nostrils/4-hands technique, improves surgical visualization and increases instrument maneuverability. Surgical access to challenging skull-base tumors is therefore afforded. The procedure also reduces nasal morbidity by preserving the lacrimal apparatus and anterior maxilla structures and avoiding septal perforation and traumatic nose traction
((Kim DH, Hong YK, Jeun SS, Park JS, Kim SW, Cho JH, Park YJ, Kim SW. Endoscopic Transseptal Approach with Bilateral Nasoseptal Flap in Challenging Skull-Base Tumors. World Neurosurg. 2018 Jul;115:e178-e184. doi: 10.1016/j.wneu.2018.03.224. Epub 2018 Apr 9. PMID: 29649644.)).