Efficacy of Endoscopic Transsphenoidal Surgery via a Mononostril Submucosal Approach

Endoscopic transsphenoidal surgery (eTSS) is the most common surgical technique for the treatment of pituitary tumor and is now widely used in the world. In general, either a mononostril or binostril approach is selected for eTSS. Several reports have suggested that the binostril approach is superior to the mononostril approach (MNA) as regards working space during surgery. However, less invasive surgery can be performed by the MNA since the nasal mucosa is completely preserved under the nasal septum mucosal approach. Even though both approaches do present advantages, there is little evidence to indicate which procedure is the superior. We summarize here our eTSS surgical results obtained via the MNA retrospectively and evaluate its usefulness. From 2015 to 2017, thirty patients with newly diagnosed pituitary tumor underwent eTSS at the Department of Neurosurgery, Nihon University Itabashi Hospital, Tokyo, Japan. All operations were performed by the same surgeon via the MNA, and the nasal mucosa was completely preserved. The patients’ mean age at the date of surgery was 57 years (range, 20–79), and the male:female ratio was 11:19. The pathological diagnosis included 16 cases of nonfunctional pituitary adenoma, 5 cases of growth hormone producing tumor, 1 case of prolactin producing tumor, 1 case of thyroid stimulating hormone producing tumor, 3 cases of Rathke’s cleft cyst, 1 case of arachnoid cyst, 2 cases of glandular cell tumor and 1 case of chordoma. Complete resection could be performed for the tumors with suprasellar extension. Although 2 cases demonstrated recurrence which required reoperation during the follow-up period and 2 cases died independently of the pituitary tumor or surgery (from heart failure and suicide), we did not experience any severe postoperative complications. One case demonstrated cerebrospinal fluid leakage which required surgical repair. In the present study, we were thus able to confirm the safety and effectiveness of eTSS via the MNA, and to evaluate the surgical technique involved. The nasal mucosa could be preserved, which is one major advantage of the MNA. However, since the postoperative nasal function, discomfort and quality of life are subjective factors, overall assessment is difficult to achieve. Long-term follow-up and the establishment of a standardized evaluation method are needed.

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