Bi-nostril transseptal endoscopic approach to the sphenoidal gate. A new technique

BACKGROUND: There are multiple approaches to reach the sellar region using microscope or endoscope, which are the old sublabial, with its post-operative morbidities, or the uni-nostril transseptal, which has a limited working field. Another technique is the direct transnasal, which is associated with tissue sacrifice, and lastly the bi-nostril (one side transseptal-other side transnasal), aiming to preserve one of the septal flaps. METHOD: We have 27 case studies using a new technique in which we access the sphenoid endoscopicaly through the nasal septum from both nostrils under the mucoperichondrial-periosteal flap. CONCLUSION: This new technique provides easy way of wide exposure to the sphenoidal gate, with easier closure of the operative field. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00701-017-3193-1) contains supplementary material, which is available to authorized users.