Skip to main content

Advertisement

SpringerLink
Log in

A modified microscopic-endoscopic bilateral transseptal approach for pituitary adenoma

  • How I Do it - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Endoscopic transnasal surgery for tumors in the sellar region has become popular across the globe. However, postoperative nasal outcomes related to endoscopic transnasal surgery have yet to be described in detail.

Method

Here, we introduce a modified microscopic-endoscopic bilateral transseptal approach for the surgical treatment of tumors in the sellar region. This technique yielded satisfactory postoperative nasal outcomes without any loss of the visual advantages associated with endoscopy.

Conclusion

The modified microscopic-endoscopic bilateral transseptal approach described herein is a minimally invasive endoscopic transnasal approach and results in satisfactory postoperative outcomes in terms of nasal structure and olfactory function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Al-Baldawi IA (2017) Bi-nostril transseptal endoscopic approach to the sphenoidal gate. A new technique. Acta Neurochir (Wien) 159:1247–1252. https://doi.org/10.1007/s00701-017-3193-1

    Article  PubMed  Google Scholar 

  2. Denzer MY, Gailer S, Kern DW, Schumm LP, Thuerauf N, Kornhuber J, Buettner A, Beauchamp J (2014) Quantitative validation of the n-butanol Sniffin’ Sticks threshold pens. Chemosens Percept 7:91–101. https://doi.org/10.1007/s12078-014-9168-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Hong SD, Nam DH, Kong DS, Kim HY, Chung SK, Dhong HJ (2016) Endoscopic modified transseptal transsphenoidal approach for maximal preservation of sinonasal quality of life and olfaction. World Neurosurg 87:162–169. https://doi.org/10.1016/j.wneu.2015.12.050

    Article  PubMed  Google Scholar 

  4. Hummel T, Kobal G, Gudziol H, Mackay-Sim A (2007) Normative data for the “Sniffin’ Sticks” including tests of odor identification, odor discrimination, and olfactory thresholds: an upgrade based on a group of more than 3,000 subjects. Eur Arch Otorhinolaryngol 264:237–243. https://doi.org/10.1007/s00405-006-0173-0

    Article  CAS  PubMed  Google Scholar 

  5. Hummel T, Sekinger B, Wolf SR, Pauli E, Kobal G (1997) “Sniffin” sticks’: olfactory performance assessed by the combined testing of odor identification, odor discrimination and olfactory threshold. Chem Senses 22:39–52. https://doi.org/10.1093/chemse/22.1.39

    Article  CAS  PubMed  Google Scholar 

  6. Little AS, Jahnke H, Nakaji P, Milligan J, Chapple K, White WL (2012) The anterior skull base nasal inventory (ASK nasal inventory): a clinical tool for evaluating rhinological outcomes after endonasal surgery for pituitary and cranial base lesions. Pituitary 15:513–517. https://doi.org/10.1007/s11102-011-0358-4

    Article  PubMed  Google Scholar 

  7. Morley AD, Sharp HR (2006) A review of sinonasal outcome scoring systems - which is best? Clin Otolaryngol 31:103–109. https://doi.org/10.1111/j.1749-4486.2006.01155.x

    Article  CAS  PubMed  Google Scholar 

  8. Zhong J, Gu Y, Zheng J, Yang B, Qi Z, Li T, Shen C, Shi Z (2022) A modified microscopic-endoscopic bilateral transseptal approach for pituitary adenomas: comparisons of nasal outcome and quality of life using the microscopic transnasal approach. Front Oncol 12:778704. https://doi.org/10.3389/fonc.2022.778704

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to thank Dr. Zengxin Qi and Dr. Zhifeng Shi for assisting with video processing.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12, Middle Urumqi Road, Shanghai, China

    Chao Shen & Bojie Yang

  2. National Center for Neurological Disorders, Fudan University, Shanghai, China

    Chao Shen & Bojie Yang

  3. Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China

    Chao Shen & Bojie Yang

  4. Neurosurgical Institute of Fudan University, Shanghai, China

    Chao Shen & Bojie Yang

  5. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China

    Chao Shen & Bojie Yang

Authors
  1. Chao Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bojie Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bojie Yang.

Ethics declarations

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of The Institutional Ethics Committee of Huashan Hospital, Fudan University, and were carried out in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The patient provided informed consent to be included in this study.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key points

1. The modified microscopic-endoscopic bilateral transseptal approach can achieve a satisfactory clinical and nasal outcome.

2. All procedures prior to endoscopic tumor resection can be completed by only one neurosurgeon with high efficiency.

3. Careful bilateral subperiosteal dissection of the septal mucosa flap is critical for this procedure.

4. The nasal speculum should be treated gently during the microscopic phase.

5. To avoid laceration of the flaps, vasoconstriction should be performed after dissecting the bilateral septal flaps.

6. In case involving postoperative nasal septal perforation, bilateral septal incisions should be made at different depths.

7. It is not easy to apply one stitch to each septal mucosa flap. This is made easier by creating an incision in the septal mucosa that is 1–2 cm in depth from the nasal vestibule.

8. The removal of bony structures during the microscope phase prior to tumor resection should be consistent with endoscopic transnasal surgery.

9. It is not easy to use this modified transnasal approach in recurrent cases.

10. The partial section of septum cartilage can be repositioned to its normal location following the procedure.

This article is part of the Topical Collection on Brain Tumors

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file 1. This video illustrates the case of the modified microscopic-endoscopic bilateral transseptal approach for pituitary adenoma. (MP4 220466 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shen, C., Yang, B. A modified microscopic-endoscopic bilateral transseptal approach for pituitary adenoma. Acta Neurochir 165, 537–541 (2023). https://doi.org/10.1007/s00701-022-05306-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-022-05306-7

Keywords

Search

Navigation