Comparing surgical freedom of four transsphenoidal approaches to the sella
Reviewed by Gauri Mankekar

Four transspenoidal approaches to the sella were performed and studied by the authors on eight silicon-injected cadaveric heads. Surgical freedom, that is, the ability of the surgeon to move his or her hands in a fixed space, was determined with stereotactic image guidance using previously established techniques. The authors studied not only the ability to move at the target point but also at the ability to move when one is fixed on the target point with the instrument and one wants to move one’s hand at the point where one is holding the instrument. Their results show that the endoscopic bi-nostril approach had the greatest surgical freedom at the pituitary gland and ipsilateral and contralateral internal carotid arteries compared to the other three approaches – microscopic sublabial; endoscopic uni-nostril and microscopic endonasal approach. The axial angle of attack was greatest for the microscopic sublabial approach while endoscopic bi-nostril was superior to the other three approaches for the saggital angle of attack. For standardisation, the authors used only straight instruments and 00 endoscopes. Angled instruments may provide different and greater surgical freedom.

Evaluation of Surgical Freedom for Microscopic and Endoscopic Transsphenoidal Approaches to the Sella.
Elhadi AM, Hardesty DA, Zaidi HA, et al.
OPERATIVE NEUROSURGERY
2015:11(1):69-79.