One-and-a-half nostril endoscopic transsphenoidal approach for pituitary adenomas—a technical report

Abstract

BackgroundBinostril endoscopic transsphenoidal approach (BETA) provides sufficient manipulation space and wide endoscopic vision, although it increases the trauma of nose. Mononostril endoscopic transsphenoidal approach (META) has minimal trauma of nose, at the expense of space within the operation. We describe a one-and-a-half nostril endoscopic transsphenoidal approach (OETA) that combines the advantages of BETA and META.MethodsWe introduced OETA for pituitary adenomas with a detailed technical description. A retrospective analysis was also performed on 57 consecutive patients who underwent one-and-a-half nostril endoscopic transsphenoidal surgery between March 2014 and June 2015 at Jinling hospital.ResultsThe gross total resection rate was 79%. The gross complete resection rate of Knosp grade 3 tumors were 63.6, and 27.3% in grade 4 tumors. Postoperative hormone remission was achieved in 14 out of 18 (77.8%) patients with secreting adenomas. Postoperative abnormal visual function improvement was achieved in 23 out of 32 patients (73%) with preoperative visual dysfunction. The overall intra-operative CSF leak was 17.5%, with the postoperative CSF leak decreased to 3.5% after the sellar reconstruction with the unilateral “rescue” nasoseptal flap procedure. The main sinonasal complaints 2 weeks after surgery were: loss of sense of smell (28%), decrease in sense of taste (4%), trouble breathing during the day (18%), thick nasal discharge (36%), post nasal discharge (8%), dried nasal material (6%), and headache (6%). Three months after surgery, there were no reports of decrease of taste, post nasal discharge, or dried nasal material. Other complaints were decreased significantly. Six months after surgery, the main complaints of sinonasal quality of life were negligible, and overall health status was near complete recovery to preoperative status.ConclusionsThe one-and-a-half nostril endoscopic transsphenoidal approach for pituitary adenomas is a simple and reliable technique. It provides not only a sufficient surgical corridor for a 2-surgeon/4 or 3-hands technique, but also ensures minimal invasion of the nasal canal.

Comparing Mononostril, Binostril, and One and a Half Nostril Endoscopic Transsphenoidal Approach for Treating Pituitary AdenomaPituitary Adenoma

“…From the technical viewpoint, the mononostril approach is a two-hand technique, and the binostril and one and a half nostril approach can be a three-hand or four-hand technique. Endoscopes create a good and extensive visualization of the surgical field [6,7]. We compared these three approaches and techniques and consider the short-term and long-term outcomes, benefits, and complications of these three approaches for pituitary adenoma surgery.…”

“…There is no prominent dissimilarity in the META and BETA groups but with a lower rate of improvement in the OETA group without any reasonable and sensible explanation (91.1% in META, 88% in BETA, and 73% in OETA) [7][8][9][10][11]. For more desirable surgical results and improvement of visual function, it is better to do an operation in the early stage of visual impairment before the occurrence of optic atrophy [20].…”

“…Post-operative MRI can detect tumor resection rate based on the amount of tumor remnant. Based on the tumor resection rate, there is no prominent dissimilarity between META, OETA, and BETA (77.8% in META, 80.3% in BETA, and 79% in OETA) [7][8][9][10][11]. However, in invasive pituitary macroadenomas (such as tumors with parasellar and suprasellar extension and tumors requiring extended approaches), the preferred approach is the binostril approach because of its better surgical field visualization, maneuverability, and resection rate [12][13][14][15][16][17].…”

“…For hormone remission rate, there is no prominent dissimilarity between three EETAs (72.9% in META, 77.8% in OETA, and 76% in BETA) [7-11, 18, 19] and also between the type of hormone-secreting adenoma [7][8][9][10][11]. The factors against biochemical remission are invasive tumors and previous operations (for microadenomas).…”

Evaluation of Surgical Freedom for One-and-a-Half Nostril, Mononostril, and Binostril Endoscopic Endonasal Transsphenoidal Approaches

“…There were no instances of postoperative arterial epistaxis or severe complications in previous cohort of 57 patients undergoing the OETA. 11 The BETA placed the posterior nasal branch of the sphenopalatine artery 23 and some nasal septum nerves at a greater risk than the mononostril approach since it crosses the nasal septum. The meta-analysis 24 revealed that the BETA group had a higher rate of epistaxis than the META group.…”