Endoscopic endonasal transsphenoidal hypophysectomy Mustafa Haseeb Atiyah & Ahmed M Al-Abbasi Bas J Surg,June, 27, 2021 12 Basrah Journal Original Article Of Surgery Bas J Surg, June, 27, 2021 A CLINICAL EXPERIENCE IN ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL HYPOPHYSECTOMY IN SKULL BASE CENTER OF BASRAH Mustafa Haseeb Atiyah * & Ahmed M Al-Abbasi @ *MB,ChB, FIBMS Specialist in ORL-H&N Surgery, Basrah Teaching Hospital. @ MB,ChB, FIBMS, FRCS, Professor of ORL-H&N Surgery, Department of Surgery, College of Medicine, University of Basrah, Basrah, IRAQ. Abstract Endoscopic Endo-nasal Trans-Sphenoidal (EETS) approach is a minimally invasive technique that has gained increased acceptability for removal of sellar and parasellar tumors. This prospective study was carried out on 50 patients in Basrah skull base center at Al-Sader Teaching Hospital between August 2017 and July 2019. The technique involved a unilateral, endoscopic, endonasal approach to the sella turcica via an anterior sphenoidotomy which is performed as a joint procedure by a consultant otolaryngologist and a consultant neurosurgeon The most common presenting symptom for pituitary tumor was; headache which present in 80% (40 patients) of the patients, followed by visual disturbance in 56% (28 patients). Infertility and hemiparesis are the least symptoms 2% for each (one patient). The MRI study of brain and sellar region showed that forty six patients (92%) was diagnosed as pituitary adenomas and one patient (2%) have Rathke’s cyst and another one have meningioma. Tumor location and extension which was assessed by MRI revealed that 70% (35 patients) had tumor located in sella with extension to suprasellar region, where only 2% (one patient) had sellar with supra- and parasellar extension. Eighty percent (40 patients) were virgin cases (not operated before), while only 20% (10 patients) were revised cases (operated before either open or transsphenoidal). We achieved complete resection of the tumor in 82% cases (41 patients). The most common method used for reconstruction of the surgical defect was underlay multilayers which was used in 62% (31 patients), while in 10%, posterior based middle turbinate flaps were used in reconstruction. We noticed that 3 patients (6%) developed significant epistaxis, CSF rhinorrhea in 3 patients (6%), and unfortunately 3 patients (6%) died postoperatively. In conclusion, this study shows that endoscopic, endonasal, transsphenoidal hypophysectomy is a minimally invasive, effective and safe procedure to remove pituitary tumors. Key words: Hypophysectomy, Endonasal, Endoscopy, Transsphenoidal. Introduction ndoscopic Endo-nasal Trans- Sphenoidal (EETS) technique has gained increased satisfactoriness for elimination of sellar and para-sellar tumors 1 . Griffith 2 first described the endonasal approach for removal of pituitary lesions in 1987 as a modification of Hirsch’s original approach. Jho et al 3 have subsequently popularized the technique. Feasibility of technique with good surgical and functional outcome has made it popular among ENT and neurosurgeons over the last two decades 4 . Preference of EETS over the conventional trans-septal and sub-labial approachs resulted from improved visualization and illumination of operative fields and low incidence of related morbidity 5 . Availability of wide angled scopes and high definition cameras allow much better control during surgery and hence significantly better results 6 . This technique has been developed under minimally invasive surgical strategies for patients with pituitary tumors, which eliminates the use of transsphenoid retraction 7,8 . The endoscope represents one of the latest E