Abstract
Background
The common complications of transnasal endoscopic pituitary adenomas resection include nasal hemorrhage, olfactory disorder, nasal adhesion, and intracranial infection. Consequently, the protection of nasal mucosa and the prevention of surgical field contamination are critical.
Method
We presented a step-by-step description of the methods of the disinfection and protection of nasal mucosa and the prevention of surgical field contamination during transnasal endoscopic pituitary adenomas resection, and these comprehensive measures to prevent these complications have not been documented.
Conclusion
These measures effectively reduce the risk of nasal mucosal injury and surgical field contamination, and are easy to perform.
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Data availability
The data and material generated during the current study are available from the corresponding author on reasonable request.
Code availability
The code used in this article is available from the corresponding author on reasonable request.
References
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Funding
It was funded by the Jining Key Research and Development Program.
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Authors and Affiliations
Contributions
All authors participated in the surgical procedure. Bo Gao participated in the perioperative management; acquired, analyzed, and interpreted the data; and drafted the manuscript. Bin Han assisted in data collection. Gengshi Gu provided critical revision of the manuscript for important intellectual content. Haitao Wang supervised the study and finalized the manuscript for publication.
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The funders had no role in any aspect of the perioperative procedures; in the writing of the manuscript, or in the decision to publish the results.
Ethical approval
This study was approved by the ethics committee of The Affiliated Hospital of Jining Medical University.
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All participants provided their written informed consent to participate in this study.
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Consent for publication was obtained from all participants.
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The authors declare no competing interests.
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Key points
1. Before performing nasal irrigation, it is imperative to meticulously remove any visible secretions within the bilateral nasal cavities using a suction device.
2. Initial nasal irrigation with 0.5% povidone-iodine solution is performed twice, which is very important for the disinfection of the nasal mucosa, taking care to maintain this step for 3 min.
3. The application of gelatin sponges soaked with povidone-iodine should be carried out after nasal irrigation to reduce the surgical field contamination by the sinuses and hidden corners of the turbinates.
4. The application of neurosurgical patty saturated with povidone-iodine should be performed after the preparation of the mucosal flap, in order to occlude the communication between the nasal cavity and the pharynx. Additionally, it also serves to disinfect the mucosal flap that is flipped towards the nasopharynx.
5. By applying gelatin sponge or neurosurgical patty soaked with povidone-iodine to occlude the opening of the sphenoid sinus on the contralateral side, it is possible to minimize surgical field contamination by the contralateral nasal cavity. There is no need to place the neurosurgical patty soaked with povidone-iodine in the contralateral nasopharynx.
6. After removal of the osseous layer enveloping the sella turcica, it is also very important to irrigate the nasal and sphenoid sinus cavities again with povidone-iodine solution and physiological saline.
7. The introduction of the soft sheath through the nostril into the nasal cavity, extending to the anterior region of the sphenoid sinus, plays a critical role in protecting the nasal mucosa and preventing contamination within the sphenoid sinus.
8. The procedure of tumor resection is consistently performed within the soft sheath, while caution is exercised to avoid introducing or removing surgical instruments through the contralateral nasal cavity.
9. The opportune moment for the extraction of the soft sheath is chosen prior to repositioning the mucosal flap, in order to protect the mucosa to the fullest extent and minimize contamination.
10. It is imperative to remove all pre-placed gelatin sponges and neurosurgical patties to ensure postoperative sinus patency and prevent adhesions.
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Gao, B., Han, B., Gu, G. et al. Intraoperative prevention of nasal mucosal injury and surgical field contamination during single-nostril transnasal endoscopic pituitary adenomas resection. Acta Neurochir 166, 114 (2024). https://doi.org/10.1007/s00701-024-05993-4
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DOI: https://doi.org/10.1007/s00701-024-05993-4