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

Abstract

Objective This article determines which of the one-and-a-half nostril, mononostril, and binostril endoscopic endonasal transsphenoidal approaches provide a superior manipulation during surgery. Methods The three approaches were orderly performed on 10 silicon-injected cadaveric heads to quantitatively assess surgical freedom and attack angle for sella. Measurements were determined with a standardized method under neuronavigation system using data of computed tomography. Results The one-and-a-half nostril endoscopic transsphenoidal approach (OETA) offered superior exposed area than that of the mononostril approach (META), and similar to that of the binostril approach (BETA). For surgical freedom at anatomic targets, the OETA showed greater surgical flexibility at pituitary center, the right medial optic carotid recess (R-mOCR), the left mOCR, the medial intersection of the right cavernous internal carotid artery, and extension line of upper margin of the clivus (R-mICC) than those of the META, and similar to those of the BETA.For sagittal angle of attack to the R-mOCR, R-mICC, and L-mOCR, the OETA can provide better angular freedom for surgeon than that of the META, and similar to that of the BETA. The OETA had the same axial attack to the pituitary center with the BETA. The OETA and the META had limited surgical freedom at L-mICC, and both inferior to the BETA. Conclusion The OETA has similar exposed area, surgical freedom, and attack angle for most anatomic targets to the BETA without resecting contralateral nasal septal mucosa, and obviously superior to the META.

Transorbital Surgical Corridor: An Anatomic Analysis of Ocular Globe Retraction and the Associated Exposure for the Transpalpebral Orbital Rim Preserving Endoscopic Orbitotomy (TORPEDO) Approach

“…However, these methods have the advantage of knowing the physiologically neutral globe position, a major limitation of previous cadaveric studies using desiccated tissue. 11,[24][25][26][27] In addition, this VR model provides the ability to use much large sample sizes than that seen with these cadaveric studies. The VR model is also unique in that it provides submillimetric precision when performing measurements in a 3-dimensional space, beyond the 3 planes available with most imaging software.…”

One-and-a-half nostril versus binostril endoscopic transsphenoidal approach to the pituitary adenomas: A prospective randomized controlled trial

“…We also compared surgical freedom and working angles between OETA and BETA in cadaveric dissection ( 10 ). The results showed that the OETA had similar surgical freedom and working angles to the BETA for most anatomic targets in the sellar or parasellar region.…”

“…In 2016, we introduced the one-and-a-half nostril endoscopic transsphenoidal approach (OETA) with the expectation of combining the advantages of the binostril and mononostril approaches ( 9 ). This approach provided superior exposure and surgical freedom and caused less damage to the nasal septum ( 10 ).…”