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The Use of a Simple Self-Retaining Retractor in the Endoscopic Endonasal Transsphenoidal Approach to the Pituitary Macroadenomas: Technical Note

Kutlay, Murat MD; Gönül, Engin MD; Düz, Bülent MD; İzci, Yusuf MD; Tehli, Özkan MD; Temiz, Çağlar MD; Solmaz, Ilker MD; Daneyemez, Mehmet MD

doi: 10.1227/01.neu.0000430292.39046.10
Instrumentation and Technique

BACKGROUND: During tumor removal in the endoscopic endonasal approach to pituitary adenomas with a significant suprasellar extension, the early descent of diaphragma sellae obscuring the visualization of the surgical field is a surgical challenge.

OBJECTIVE: To describe a simple diaphragma retraction technique to eliminate this problem.

METHODS: A transparent flexible material (a strip of polypropylene) was used as a self-retaining retractor to elevate the redundant diaphragma and to maintain the diaphragma elevation. This technique was performed in 3 patients who had pituitary adenoma with suprasellar extension. The degree of tumor removal was determined by a combination of surgeon's intraoperative impression and the postoperative magnetic resonance imaging obtained 3 months later.

RESULTS: The technique was performed very easily and no complication was observed owing to this technique and self-retaining retractor. Total tumor removal was achieved in 2 patients with this technique and subtotal removal in 1 patient.

CONCLUSION: This technique was effective and practicable to elevate the diaphragma sellae during the tumor removal phase of transsphenoidal surgery. This simple self-retaining retractor may support the neurosurgeon's skill by providing control of the entire surgical field and adequate working space. It may also eliminate the risks of blind curettage during surgery.

Department of Neurosurgery, Gulhane Military Medical Academy, Etlik-Ankara, Turkey

Correspondence: Yusuf Izci, MD, Gulhane Askeri Tıp Akademisi, Norosirurji AD, 06018 Etlik/Ankara, Turkey. E-mail:;

Received January 09, 2013

Accepted March 21, 2013

Copyright © by the Congress of Neurological Surgeons