Transsphenoidal Surgery: How Its Done, What To Expect - Page 2

The dura is incised in a cruciate manner after coagulating it with the bipolar electrocautery (Figure 7). Intercavernous venous channels that extend across the sella frequently result in brisk bleeding when the dura is incised The bleeding can be controlled by grasping both, leaves of the dura with the bipolar forceps and coagulating.

Pituitary adenomas usually are soft and can be readily removed with bayonetted ring curettes. Intermittent. Valsalva maneuvers by the anesthesiologist expedite tumor removal by elevating the subarachnoid fluid pressure, which is transmitted to the tumor capsule, displacing tumor tissue downward.

After the bulk of the tumor is removed, the sella is inspected systematically and the pituitary gland itself is examined. If the tumor capsule prolapses into the sphenoid sinus or cerebrospinal fluid leakage occurs, fascia lata or adipose tissue and fibrin glue may be used to occlude the communication to the subarachnoid space and support the diaphragma sellae. The floor of the sella can be reconstructed vvith the bony septum previously removed. After complete hemostasis is achieved, the speculum is removed and the sublabial mucosa is closed with interrupted absorbable structures.

Petroleum jelly-covered gauze is packed into each nasal passage and left in place for 48 to 72 hours.

In the case of extensive dural defect, lumbar cerebrospinal fluid drainage for 2 to 3 days is advisable.

Figure 5 Visualization of the characteristic
keel of the sphenoid sinus.