Bi-nostril transseptal endoscopic approach to the sphenoidal gate. A new technique

Al-Baldawi, Ihsan Abbas

doi:10.1007/s00701-017-3193-1

Cited by 8 publications

(7 citation statements)

References 8 publications

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“…A stable working space between bilateral nasal septal mucosa is a prerequisite for ensuring the maneuverability of the instruments. Many methods have been reported, such as a tagging suture between the septal mucosa and vestibule ( 5 ) or using a nasal speculum ( 7 ). However, suturing may tear the vulnerable mucosa and the hard blades of the nasal speculum severely restrict the lateral movement of the endoscope and instruments.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic 1½-transseptal approach for pituitary surgery

Cong

Zhu²,

Sun³

et al. 2023

Front. Oncol.

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BackgroundWe previously introduced the one-and-a-half (1½) nostril endoscopic transsphenoidal approach (OETA) to reduce the damage to the nasal structures. Here, we reported the modified approach which is called the endoscopic 1½-transseptal approach (EOTA) for pituitary surgery by combining the OETA and the microscopic transseptal approach to simplify intranasal procedures and protect nasal mucosa. In EOTA, we removed the sellar lesions in a corridor that is composed of the right submucosal space and the anterior left ½ nasal cavity.MethodsWe introduced EOTA with a detailed technical description and preliminary clinical outcomes. A total of 128 patients who underwent EOTA for pituitary surgery from July 2018 to September 2020 were reviewed for evaluation of the safety and efficacy of this approach.ResultsEOTA had a high gross total resection (GTR) rate and a 1ow complication rate. GTR was achieved in 106 (82.8%) patients, with 81.4% for pituitary adenomas and 93.3% for other non-adenomatous lesions. Post-operative complications included 3 patients (2.3%) with postoperative cerebrospinal fluid leak, 3 patients (2.3%) with diabetes insipidus, 5 patients (3.9%) with anterior pituitary insufficiency and 2 patients (1.6%) with meningitis. In addition, EOTA simplified the intranasal procedures, which led to shortened operation time (67.8 minutes). The results of ASK nasal-12, the Lund-Kennedy score, and the odor identification test showed that patients who underwent EOTA recovered quickly after surgery and the nasal cavity returned to the preoperative condition both apparently and physiologically one month after surgery.ConclusionsEOTA is a simple, safe and effective approach for pituitary lesions, which provides not only a sufficient surgical corridor for 2-surgeon/4- or 3-hands technique but also minimally invasive access to the sellar region.

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Section: Discussionmentioning

confidence: 99%

Endoscopic 1½-transseptal approach for pituitary surgery

Cong

Zhu²,

Sun³

et al. 2023

Front. Oncol.

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“…The treatment of choice for sphenoid sinus lesions is surgery. [1][2][3][4][5][6] Endoscopic sphenoid surgery is the technique of choice through several approaches, including transnasal, transethmoidal, transseptal, and transpterygoid approaches. [1][2][3] In this study, 8 cases with lesions in the other sinuses including sphenoid sinus were operated through a transethmoid approach.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Because there are many critical structures around the sphenoid sinus, sphenoid sinus lesions require surgical treatment. [1][2][3][4][5][6] We considered an effective surgical approach when there were bilateral isolated sphenoid sinus lesions or lesions in other sinuses including sphenoid sinus on one side and isolated sphenoid sinus lesions on the opposite side. A mononostril endoscopic approach was attempted for bilateral sphenoid sinus lesions.…”

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confidence: 99%

Mononostril Endoscopic Approach for Bilateral Sphenoid Sinus Lesions

Lee

Jeong

Lim

2022

Journal of Craniofacial Surgery

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Introduction: A mononostril endoscopic approach was attempted for bilateral sphenoid sinus lesions. The objective of this study was to introduce the surgical method along with treatment results for patients. Methods: We retrospectively analyzed 16 patients who underwent a mononostril endoscopic surgery for bilateral sphenoid lesions from 2018 to 2022. Results: Endoscopic mononostril surgery for bilateral sphenoid lesions was performed for 13 cases under general anesthesia and 3 cases under local anesthesia. The surgical approach to the sphenoid sinus was transnasal approach in 8 cases and transethmoidal in 8 cases. Among those with bilateral sphenoid sinuses lesions, fungal ball and sinusitis were the most common. After surgery, the size of the sphenoid sinus opening remained almost the same in 14 patients. It decreased but maintained in 2 patients. There was no recurrence of sphenoid lesions. Conclusion: The mononostril endoscopic approach for bilateral sphenoid lesions is a feasible, safe, effective, and minimally invasive surgical technique.

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“…It has been reported that compared with the endoscopic approach, microscopic pituitary surgery provides better early postoperative sinonasal quality of life (QoL) and comparable olfactory outcomes ( 19 ). However, numerous modified endoscopic transnasal approaches have been developed to further protect the postoperative integrity of nasal function, such as the single-nostril transseptal transsphenoidal approach ( 20 ), the bilateral modified nasoseptal rescue flaps approach ( 21 ), the bilateral transseptal approach (with the help of a nasal speculum) ( 22 ), and the binostril approach (one side transseptal with the other side transnasal) ( 23 ). All approaches have shown good postoperative olfactory function and sinonasal QoL; however, few have been compared with typical uninostril transnasal microscopic approaches.…”

Section: Introductionmentioning

confidence: 99%

A Modified Microscopic-Endoscopic Bilateral Transseptal Approach for Pituitary Adenomas: Comparisons of Nasal Outcome and Quality of Life Using the Microscopic Transnasal Approach

Zhong

Zheng

et al. 2022

Front. Oncol.

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ObjectivesIn this study, we introduced a novel modified microscopic-endoscopic bilateral transseptal approach for pituitary adenoma resection to minimize surgery-related nasal injury. We also retrospectively compared comprehensive nasal outcomes and quality of life between the microscopic transnasal approaches.MethodsPatients with pituitary adenomas who underwent modified microscopic-endoscopic bilateral transseptal or microscopic transnasal approaches were assessed for olfactory function and quality of life using the Sniffin’ Sticks test, the Sino-Nasal Outcome Test-22 (SNOT-22), the SF-36, the anterior skull base (ASK) nasal inventory, and the subjective visual analog scale (VAS) before and 1 and 3 months after surgery. A nasal endoscopy procedure was also performed to evaluate structure abnormalities at 1 and 3 months after surgery.ResultsFifty-eight patients who underwent either modified microscopic-endoscopic bilateral transseptal (35 patients) or microscopic transnasal (23 patients) surgery were consecutively enrolled. Patients who underwent either transnasal approach experienced similar surgical complications, except for intraoperative cerebrospinal fluid leakage (43.5% vs 14.3% for modified microscopic-endoscopic bilateral transseptal or microscopic transnasal approach, respectively; p = 0.013). Patients who underwent the two approaches fully recovered according to the SF-36, SNOT-22, VAS, and Sniffin’ Sticks surveys, but not ASK scores, 3 months post-operatively. There was no significant difference in nasal endoscopy outcome at 3 months follow-up between the two approaches.ConclusionsThe modified microscopic-endoscopic bilateral transseptal approach showed largely similar nasal mucosa protective outcomes to those of the microscopic transnasal approach for pituitary adenoma surgery. After pituitary adenoma resection using the modified approach, patients’ postoperative olfactory function, nasal structure, and quality of life can be restored to preoperative status within 3 months.

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Bi-nostril transseptal endoscopic approach to the sphenoidal gate. A new technique

Cited by 8 publications

References 8 publications

Endoscopic 1½-transseptal approach for pituitary surgery

Endoscopic 1½-transseptal approach for pituitary surgery

Mononostril Endoscopic Approach for Bilateral Sphenoid Sinus Lesions

A Modified Microscopic-Endoscopic Bilateral Transseptal Approach for Pituitary Adenomas: Comparisons of Nasal Outcome and Quality of Life Using the Microscopic Transnasal Approach

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