Chopsticks mononostril endoscopic endonasal approach for adult Craniopharyngioma: A retrospective comparative cohort...

To assess the technical feasibility of the mononostril chopsticks endoscopic endonasal approach for adult craniopharyngioma and to evaluate 3-month outcomes relative to the binostril cohort.

We retrospectively analyzed 107 adult patients with pathologically confirmed craniopharyngioma and available 3-month follow-up data who underwent endoscopic endonasal surgery at West China Hospital. Patients treated with the mononostril chopsticks technique between February 2025 and February 2026 comprised the mononostril cohort (n = 51), whereas those treated with the conventional binostril approach between February 2024 and February 2025 comprised the binostril cohort (n = 56). Research assistants who were not informed of the surgical approach administered the questionnaires. Three-month questionnaires were completed face-to-face during outpatient follow-up, whereas preoperative scores were obtained retrospectively by telephone interview. The primary outcome was the EES-Q total score at 3 months. Secondary outcomes included SNOT-22 and VAS scores, perioperative outcomes, extent of resection, visual and endocrine outcomes, and complications.

Baseline characteristics were similar between treatment periods. Operative time did not differ significantly after adjustment (adjusted mean difference, -14.33 min; 95% CI, -33.87 to 5.21; P = 0.149), whereas hospital stay was shorter during the mononostril period (-1.25 days; 95% CI, -2.07 to - 0.43; P = 0.003). Gross-total resection rates were 82.4% and 71.4%, respectively (adjusted odds ratio, 2.27; 95% CI, 0.86 to 6.01; P = 0.098). No statistically significant differences were detected in the adjusted visual or overall-complication analyses; endocrine outcomes were summarized descriptively because valid at-risk denominators were unavailable. Adjusted EES-Q total and SNOT-22 scores were lower during the mononostril period, with differences of - 9.39 and - 8.57 points, respectively (both P < 0.001). Selected VAS and EES-Q domain outcomes also remained significant after false-discovery-rate correction. Wide confidence intervals precluded conclusions of equivalence.

The mononostril chopsticks technique was technically feasible in the included patients. Treatment during the mononostril period was associated with lower baseline-adjusted 3-month patient-reported symptom scores. However, these associations cannot be separated from treatment-era effects and should not be interpreted as evidence of superiority or causality.