Endoscopic endonasal trans-sphenoidal approach for pituitary adenomas: Is one nostril enough?

• Published in: Acta neurochirurgica Vol. 155; no. 9; pp. 1601 - 1609
• Main Authors: Han, Sheng, Ding, Xiaoxu, Tie, Xinxin, Liu, Yuan, Xia, Junze, Yan, Aihui, Wu, Anhua
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.09.2013; Springer Nature B.V
• Subjects: Adenoma - surgery; Adult; Aged; Clinical Article - Brain Tumors; Endoscopy - methods; Female; Humans; Interventional Radiology; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Nasal Cavity - surgery; Neurology; Neuroradiology; Neurosurgery; Nose - surgery; Pituitary Neoplasms - pathology; Pituitary Neoplasms - surgery; Retrospective Studies; Sphenoid Bone - pathology; Sphenoid Bone - surgery; Surgical Orthopedics; Treatment Outcome; Young Adult; Transsphenoidal; Endoscopic surgery; Minimally invasive; Pituitary adenoma
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-013-1788-8

Background Over the past decade, the endoscopic endonasal trans-sphenoidal approach has been used to resect pituitary adenomas. However, in the use of this procedure, some research teams prefer a two-nostril method, whereas other groups are in favor of the one-nostril method. Here, we present a series of pituitary adenomas and try to confirm whether or not one nostril is enough for endoscopic resection of most pituitary adenomas. Methods A total of 250 consecutive patients who underwent an endoscopic endonasal trans-sphenoidal approach were reviewed retrospectively, of which 200 were via the unilateral nostril (group 1) and 50 were via bilateral nostrils (group 2). Surgical and clinical outcomes were analyzed. Results For microadenomas, intrasellar macroadenomas and macroadenomas with moderate extrasellar extension, the prevalence of gross total resection (GTR), hormonal outcome and visual improvement were similar between the two groups. The one-nostril group had better results for duration of surgery and blood loss, with fewer rhinological complications. However, for macroadenomas with extensive extrasellar invasion, GTR was obtained in two of seven patients in group 2 but none in group 1. Conclusion The one-nostril method, which is relatively fast and minimally invasive, is adequate for endoscopic resection of most pituitary adenomas with moderate extension.