A Novel Technique for Transpalatal Hypophysectomy.

 A novel technique is described for transpalatal hypophysectomy as an option for sellar region surgery using a microscope and/or endoscope.  A straight submucosal tunnel (approximately 20 mm in diameter; 40-50 mm long-half the length required by conventional transsphenoidal hypophysectomy) is dissected in favorable alignment with the main tumor axis, providing a direct view that allows the surgeon to operate on large suprasellar tumors, even in cases of extra-axial expansion.  In a 25-year period, over 50 patients benefited from this surgery.

Petrous apex cholesterol granulomas: endonasal versus infracochlear approach.

Objectives/hypothesis: The aim of this study was to investigate and compare the surgical anatomy of two different routes to access and drain petrous apex (PA) cholesterol granulomas: the expanded endonasal approach (EEA) and the transcanal infracochlear approach (TICA).

Study Design: Anatomic and radiologic study.

Methods: The EEA and TICA to the PA were performed in 11 anatomic specimens with the assistance of imaging guidance.

Endoscopic endonasal approach to cholesterol granulomas of the petrous apex: a series of 17 patients: clinical article.

Object: The aim of this study was to report the results in a consecutive series of patients who had undergone an endoscopic endonasal approach (EEA) for drainage of a petrous apex cholesterol granuloma (CG).

Methods: Seventeen cases with a confirmed diagnosis of petrous apex CG were identified from a database of more than 1600 patients who had undergone an EEA to skull base lesions at the authors' institution in the period from 1998 to 2011. Clinical outcomes were reviewed and compared with those in previous studies of open approaches.