An incision the nasal mucosa of the Septum as posterior as possible is made, and the septum is exposed submucosly with a combination of sharp and blunt dissection.

The articulation of the cartilaginous septum with the maxilla is then dissected free.

A self retaining Hardy’s nasal speculum is introduced through the tunnel; the septum is then pushed aside as a single muco-perichondral flap with the controlateral mucosa The two mucosae are dissected on both side of the sphenoid and pushed aside by the speculum tips. The perpendicular plate of the ethmoid and the sphenoid face are exposed.

Portions of the bony nasal septum in the operative field should be resected, and preserved for use during closure, in case the need arises. Preserving the nasal spine, helps cosmetically. The anterior wall of the sphenoid is opened by grasping the vomer with a punch; chisel may be required at times. The exposure is widened with an angled punch.

The sellar floor should be visible now. Often, the sellar floor is eroded or extraordinarily thin, and can be fractured with a blunt hook; at times a chisel or even a drill may be required.

The residual tumor is removed with blunt curette and forceps. Excessive use of suctioning is avoided. Tumor removal starts inferiorly, and proceeded laterally, from inferior to superior aspects removing tumor. Next the central portion is removed, followed by the superior portion. This orderly removal is recommended and minimizes trauma to the pituitary stalk and secondarily to the hypothalamus, and also avoid entrapment of more laterally placed tumor.

Following adequate removal, the diaphragma sellae is seen descending down into the operative field, and reinforce with a fascia lata graft and fibrin glue.