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The available operation range in clivus and anterior cranial base by transsphenoidal opproach was also observed during the operation under the help of neuronavigational pointer. Forty-one patients underwent sublabial, transseptal, transsphenoidal approach to the pituitary region guided by Surgical Microscope Navigation was studied. The piriform aperture was 27. 2mm±3. 1 , the origin of inferior nasal concha 30mm±4. 1, the origin of middle nasal concha 27. 9mm±4. 3. These data are important for transsphenoidal approach, because the piriform aperture and the origin of both inferior and middle nasal conchas restricted the opening width of the Hardy specula. If any distance of these bony structures was much less than the mean one, may cause inadequate opening of the specula blade and resulting dissatisfied operative field. Microadenomas or cystic tumors perhaps can be operated even in a narrow exposure, but large or giant solid adenomas may need a proper evaluation including changing the operative approach or performing a bilateral submucous inferior conchotomy or posterior ethmoidectomy firstly.
手术中还利用CT导航系统观察棒研究了经口—鼻蝶窦入路在斜坡区和前颅底能够达到的实际有效操作范围，为扩大经蝶窦入路手术在斜坡区和前颅底的应用奠定基础，在国内外尚未见同类报道。41例垂体瘤患者梨状孔平均宽度27.2mm±3.1，下鼻甲根部附着处间距30mm±4.1，中鼻甲根部附着处间距27.9mm±4.3，这是经口—鼻蝶窦入路手术中，对Hardy双瓣鼻窥器张开限制的主要骨性结构，若患者这些径线值明显小于平均值，则可能因为鼻窥器打开不充分而影响手术暴露，当然对于垂体微腺瘤和以囊变为主的垂体瘤可能影响不大，但对于大和巨大垂体瘤必须要有充分的准备，包括评估是否改用其他入路，或先行鼻甲切除再行经蝶手术。
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MethodsWith nasal endoscopy and microscopy, the middle conchas were moved outside by Hardy′s stretcher, the nasal cavities were broadened, the frontal walls of sphenoid sinus were opened, and the lesions were removed.
方法鼻内镜下用Hardy′s撑开器外移中鼻甲，扩大鼻腔，直达并开放蝶窦前壁，联合显微镜切除病变。
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conchotome：鼻甲刀 鼻甲切除器
conchospiral 放射对数螺线 | conchotome 鼻甲刀 鼻甲切除器 | conchotomy 鼻甲切开术
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partial inferior turbinectomy：下鼻甲部分切除术
(2)下鼻甲部分切除术:下鼻甲部分切除术(partial inferior turbinectomy)是在局麻 下以下鼻甲剪或吸切器切除鼻甲肥大的部分(图1-8-1). 切除部分一般不要超过下鼻甲的1/3,如切除过多有可能发生继发性萎缩性鼻炎. 还可先将下鼻甲 向内骨折移位,
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turbinotome：鼻甲刀 鼻甲切除器
turbining 涡轮清垢 | turbinotome 鼻甲刀 鼻甲切除器 | turbo 透平