Modified microscopic-endoscopic bilateral transseptal approach

Zhong et al. introduced a novel modified microscopic-endoscopic bilateral transseptal approach for pituitary neuroendocrine tumor resection to minimize surgery-related nasal injury. They also retrospectively compared comprehensive nasal outcomes and quality of life between the microscopic transnasal approaches.

Patients with pituitary neuroendocrine tumors who underwent modified microscopic-endoscopic bilateral transseptal approach or microscopic transnasal approaches were assessed for olfactory function and quality of life using the Sniffin' Sticks test, the Sino-Nasal Outcome Test-22 (SNOT-22), the SF-36, the anterior skull base (ASK) nasal inventory, and the subjective visual analog scale (VAS) before and 1 and 3 months after surgery. A nasal endoscopy procedure was also performed to evaluate structure abnormalities at 1 and 3 months after surgery.

Fifty-eight patients who underwent either modified microscopic-endoscopic bilateral transseptal (35 patients) or microscopic transnasal (23 patients) surgery were consecutively enrolled. Patients who underwent either transnasal approach experienced similar surgical complications, except for intraoperative cerebrospinal fluid leakage (43.5% vs 14.3% for modified microscopic-endoscopic bilateral transseptal or microscopic transnasal approach, respectively; p = 0.013). Patients who underwent the two approaches fully recovered according to the SF-36, SNOT-22, VAS, and Sniffin' Sticks surveys, but not ASK scores, 3 months post-operatively. There was no significant difference in nasal endoscopy outcome at 3 months follow-up between the two approaches.

The modified microscopic-endoscopic bilateral transseptal approach showed largely similar nasal mucosa protective outcomes to those of the microscopic transnasal approach for pituitary neuroendocrine tumor surgery. After pituitary neuroendocrine tumor resection using the modified approach, patients' postoperative olfactory function, nasal structure, and quality of life can be restored to preoperative status within 3 months ¹⁾.