‘The columellotomy modification’ of transseptal hypophysectomy

Objective: Although the transseptal approach to the sella turcica is the most common method by which the pituitary tumors are resected, it is not suitable for the noses with narrow nostrils, precluding the placement of the neurosurgical speculum. In this paper, as a solution for this problem, ‘the columellotomy modification’ of the transseptal approach is suggested and described together with the results in five patients. Methods: In five patients, the distance between the outer edges of the two blades of the neurosurgical speculum was measured after positioning the neurosurgical speculum through the hemitransfixion incision, and after positioning the neurosurgical speculum through ‘the columellotomy’ incision. The increase in distance after hemitransfixion incision with respect to the width of the nostril was statistically compared with the increase in distance after ‘columellotomy’ incision with respect to the width of the nostril. The postoperative complaints and cosmetic results were evaluated. Results: By paired-samples t-test, the comparison between the values of increase revealed a statistically significant difference (P=0.011). A complaint of numbness on the columellar skin was noted in three of the five patients. Cosmetic results were satisfactory. Conclusion: ‘The columellotomy modification’ offers a wide, direct and fast exposure to the sella turcica without a cosmetic disadvantage in noses with narrow nostrils.