One-nostril endoscopic endonasal approach for pituitary macroadenoma resection

Abstract

Introduction: Endoscopic techniques have become the standard approach for pituitary adenoma surgery, providing improved visualization of the hypophyseal fossa and facilitating precise tumor resection while minimizing surgical morbidity. The one-nostril endoscopic approach further enhances minimally invasive surgery by reducing nasal mucosal trauma and optimizing access to the tumor, thereby improving surgical precision and reducing the risk of postoperative complications

Patients and Methods: Between September 2024 and February 2025, a retrospective analysis was conducted on 12 consecutive patients who underwent one-nostril endoscopic transsphenoidal surgery at Viet Duc University Hospital and Hanoi Medical University. Furthermore, we provide a step-by-step description of the surgical procedure of the single-nostril endoscopic endonasal approach.

Results:  The gross total resection rate was 66,7%. The mean tumor volume was 8,4 cm³. Postoperative abnormal visual function improvement was achieved in 6 out of 7 patients. Intraoperative cerebrospinal fluid (CSF) leakage occurred in 2 patients, both of whom required reconstruction using a fat graft and postoperative lumbar puncture. Notably, no postoperative CSF leaks were reported. No other postoperative complications were observed.

The most common sinonasal complaint was nasal obstruction or difficulty breathing (41.7%) immediately after surgery, which subsided within 2–3 weeks. At the time of follow-up (mean: 51.6 days), no patients reported loss of smell, and the overall health status had nearly returned to preoperative levels.

Conclusions: The one-nostril endoscopic approach is a safe and effective technique for pituitary macroadenoma resection, offering reduced mucosal trauma and fewer postoperative complications while minimizing sinonasal morbidity and enhancing patient recovery.

Keywords: One-nostril, pituitary macroadenoma, endoscopic endonasal approach, surgical outcomes, gross total resection.

References

1. Dong Van He, Le Cong Dinh, and T. T. T. Hang (2013). “Endoscopic surgery for pituitary adenomas – initial results and new perspectives.” Vietnamese Journal of Medicine, 405, pp. 67–68.
2. Kieu Dinh Hung, Nguyen Tien Hung, and Cao Minh Thanh (2012). “Endoscopic surgery for sellar region tumors at Hanoi Medical University Hospital.” Ho Chi Minh City Journal of Medicine, 201.
3. Baussart B, Declerck A, Gaillard S. Mononostril endoscopic endonasal approach for pituitary surgery. Acta Neurochir (Wien). 2021;163(3):655-659. doi:10.1007/s00701-020-04542-z
4. Cavallo LM, Messina A, Cappabianca P, et al. Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations. Neurosurg Focus. 2005;19(1):E2.
5. Labidi M, Watanabe K, Hanakita S, et al. The chopsticks technique for endoscopic endonasal surgery–improving surgical efficiency and reducing the surgical footprint. World Neurosurg. 2018;117:208-220.
6. Prevedello DM, Ebner FH, de Lara D, Ditzel Filho L, Otto BA, Carrau RL. Extracapsular dissection technique with the cotton swab for pituitary adenomas through an endoscopic endonasal approach — how I do it. Acta Neurochir (Wien). 2013;155(9):1629-1632. doi:10.1007/s00701-013-1766-1
7. Cavallo LM, Solari D, Somma T, Cappabianca P. The 3F (Fat, Flap, and Flash) Technique For Skull Base Reconstruction After Endoscopic Endonasal Suprasellar Approach. World Neurosurg. 2019;126:439-446. doi:10.1016/j.wneu.2019.03.125
8. Joustra GE, Ten Dam E, Vermeulen KM, Korsten-Meijer AGW, Appelman APA, Feijen RA. Prospective evaluation of multidimensional health-related quality of life after endoscopic endonasal surgery for pituitary adenomas using the endoscopic endonasal sinus and skull base surgery questionnaire. Laryngoscope Investig Otolaryngol. 2023;8(1):7-15. doi:10.1002/lio2.1004
9. Kassam AB, Prevedello DM, Carrau RL, et al. Endoscopic endonasal skull base surgery: analysis of complications in the authors initial 800 patients: A review. J Neurosurg. 2011;114(6):1544-1568. doi:10.3171/2010.10.JNS09406
10. Agam MS, Zada G. Complications Associated With Transsphenoidal Pituitary Surgery: Review of the Literature. Neurosurgery. 2018;65(CN_suppl_1):69-73. doi:10.1093/neuros/nyy160.