Abstract
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.
Highlights
Surgical approaches in the sellar region have evolved during the past century
We retrospectively reviewed all patients who underwent pituitary tumor resection using the modified microscopic-endoscopic bilateral transseptal approach and the microscopic transnasal approach by the same surgeon (B.Y.) at Huashan hospital between March 2019 and January 2021
There were no significant differences in age, sex, length of hospital stay, or Knosp grade between the two approach groups (Table 1)
Summary
Surgical approaches in the sellar region have evolved during the past century. In the 1897, Davide Giordano, a Venetian anatomist and surgeon, proposed a transglabellar approach to the pituitary involving resection of the nose and frontal sinus, followed by removal of the ethmoid bone, allowing wide access to the sphenoid sinus and sella [1]. The endoscope provides a panoramic view of the suprasellar and parasellar compartments, especially with the use of an angled endoscope This enhanced visualization has enabled improvements in the extent of resection and reductions in hospital stay duration and operative complications compared with those following the traditional microscopic transnasal transsphenoidal approach [4,5,6,7]. 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]. In this paper, we introduced a new modified microscopic-endoscopic bilateral transseptal approach without the use of a speculum and compared postoperative sinonasal QoL, QoL, olfactory function, and nasal structure integrity outcomes with those of the traditional microscopic trans-nasal approach for pituitary adenoma resection
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