Donald P. Becker, M.D.
The transsphenoidal approach is the procedure of choice for the removal of tumors of the sella that are still largely confined to this space. It is also indicated for removal of some tumors of the parasellar area. Pituitary tumors with substantial intracranial extension can engulf important structures and should be treated using a transcranial approach.
For transsphenoidal surgery, there are several alternative approaches to the sphenoid sinus. These include the transnasal paraseptal, sublabial-transseptal, and paranasal transethmoidal approaches. For processes that are largely located in the sella, the sublabial or trananasal approach is used. With extreme involvement of the paranasal sinuses, the paranasal transethmoidal exposure is of benefit.