Advantages of microscopic TSA - Comfort & Familiarity to neurosurgeon - Tree-dimensional view : Pseudo-depth perception in Endoscope - Easily manipulated zoom and focus features - Nasal speculum protects the nasal mucosa from injury - Microscope is out of the surgical field and does not obstruct the entry or maneuvering of instruments into or out of field - Don’t need to hold microscope
Traditional Endoscopic TSA Traditional endoscopic TSA concentrated on safe and wide access - Cauterization of anterior sphenoid, posterior septum - Transection of posterior septum - Removal of rostrum of sphenoid - Resection of posterior edge of septum - Enlargement of sphenoidotomy - Cauterization of Posterior nasal artery
Current Concept of Endoscopic TSA - You can remove the bone as wide as possible. - You can preserve the mucosa as much as possible.
Key principle of Endoscopic TSA - Wide Exposure and Good Visualization. - Preservation of Anatomy and Function - Dedicated biopolar coagulator - Irrigation System
Preparation 1) Nasal stage - Warm/hot saline(over 40℃) irrigation : prevent mucosal swelling - 2hr operation time-rule : assoc with mucosal swelling - Strict I/O balance for long-time surgery
2) Sphenoid Stage - Anticipation of intrasphenoid septa / Onodi air cell - Sphenoid mucosa : stripped by gentle maneuver - Sphenoid opening