The sella holds the pituitary gland and any associated tumor. Many neurosurgeons use a direct transnasal approach to the sella, in which an incision is made in the back of the nose to enter the front of the sphenoid sinus directly. It is also possible to make an incision along the front of the nasal septum, and create a narrow tunnel back to the sphenoid sinus. Finally, it is possible to make an incision under the lip and enter the nasal cavity and then the sphenoid sinus. This is called a “sublabial” approach.
The opening through which transsphenoidal surgery is performed is long and narrow. Therefore, visual aids are necessary for the neurosurgeon to see the tumor with clarity. A number of tools are available to help see the pituitary gland and the tumor through this narrow channel. These tools include high powered operating microscopes and rigid fiberoptic endoscopes. The operating microscope allows “binocular” vision with high quality optics. This is very important for tiny tumors, like those responsible for causing Cushing’s Disease. The endoscope provides a wider field of view, but usually with “monocular” images projected on a video monitor. Both means of visualization are highly effective.