Patients were laid in the supine position with the head tilted back approximately 20°. A right nostril approach was used. Under the operating microscope, the nasal septum mucosa was cut transversely 2.5 cm from the tip of the nose and separated to the anterior wall of the sphenoid sinus. At the junction of the vertical plate of the ethmoid bone and the anterior wall of the sphenoid sinus, the bone of the nasal septum was broken and pushed away to the opposite side. A nasal dilator was used to stretch the nasal septum mucosa on both sides and expand the visual field of the anterior wall of the sphenoid sinus. After having confirmed the ostium of the sphenoid sinus, the anterior wall of the sphenoid sinus was ground off, the sphenoid sinus was entered, the septum of the sphenoid sinus was ground off, the sellar base was identified and exposed, and a bone window was opened with a diameter of 1.5–2 cm in the anterior wall of the sellar base. An X-cut of the dura mater at the bottom of the saddle was made to observe the tumour tissue. The tumour was carefully removed using a suction device, a scraping ring, and tumour forceps in a back, top, and front order. The surrounding normal pituitary tissue was fully identified and preserved. A gelatin sponge was used to stem the bleeding. Finally, freeze-dried fibrin glue (Shanghai Laishi 2 mL/branch) was used to fix the tissue. If cerebrospinal fluid leakage occurred intraoperatively, the sellar base was closed with an artificial dura. Osseous reconstruction of the sellar floor and foreign body packing in the sphenoid sinus cavity were not performed. Both nasal cavities were filled with surgical polyvinyl alcohol sponge and removed on post-operative day three.
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