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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
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Endoscopic 1½-transseptal approach for pituitary surgery
Zixiang Cong1, Junhao Zhu1, Huaiyu Sun2
1Department of Neurosurgery, Affiliated Jinling Hospital, Medicine School of Nanjing University, Nanjing, Jiangsu, China.
Frontiers in Oncology
|January 30, 2023
Summary
The endoscopic 1½-transseptal approach (EOTA) offers a safe and effective method for pituitary surgery, simplifying procedures and promoting quick nasal recovery. This minimally invasive technique achieves high resection rates with low complication risks.
Area of Science:
- Neurosurgery
- Endoscopic Surgery
- Pituitary Surgery
Background:
- The one-and-a-half (1½) nostril endoscopic transsphenoidal approach (OETA) was previously developed to minimize nasal structure damage.
- The endoscopic 1½-transseptal approach (EOTA) is a modified technique combining OETA and microscopic transseptal approaches for pituitary surgery.
- EOTA aims to simplify intranasal procedures and preserve nasal mucosa by utilizing a surgical corridor through the right submucosal space and anterior left ½ nasal cavity.
Purpose of the Study:
- To introduce and technically describe the endoscopic 1½-transseptal approach (EOTA) for pituitary surgery.
- To evaluate the preliminary clinical outcomes, including safety and efficacy, of the EOTA.
- To assess the impact of EOTA on intranasal procedures, surgical corridor, and patient recovery.
Main Methods:
- Detailed technical description of the endoscopic 1½-transseptal approach (EOTA).
- Retrospective review of 128 patients who underwent EOTA for pituitary surgery between July 2018 and September 2020.
- Evaluation of safety and efficacy through gross total resection (GTR) rates, complication rates, operation time, and nasal cavity recovery assessments (ASK nasal-12, Lund-Kennedy score, odor identification test).
Main Results:
- High gross total resection (GTR) rate of 82.8% (81.4% for pituitary adenomas, 93.3% for other lesions).
- Low complication rate, including 2.3% cerebrospinal fluid leak, 2.3% diabetes insipidus, 3.9% anterior pituitary insufficiency, and 1.6% meningitis.
- Shortened operation time (67.8 minutes) and rapid nasal cavity recovery, both apparent and physiological, one month post-surgery.
Conclusions:
- The endoscopic 1½-transseptal approach (EOTA) is a simple, safe, and effective technique for pituitary lesions.
- EOTA provides a sufficient surgical corridor for complex surgical techniques (2-surgeon/4- or 3-hands).
- The approach offers minimally invasive access to the sellar region with good patient outcomes and nasal recovery.
