1Department of Neurosurgery, Clinical Neuroscience Center.
2Department of Otorhinolaryngology, Head and Neck Surgery; and.
Neurosurg Focus. 2020 Jun;48(6):E15. doi: 10.3171/2020.3.FOCUS2065.
The "chopsticks" technique is a 3-instrument, 2-hand mononostril technique that has been recently introduced in endoscopic neurosurgery. It allows a dynamic surgical view controlled by one surgeon only while keeping bimanual dissection. Being a mononostril approach, it requires manipulation of the mucosa of one nasal cavity only. The rationale of the technique is to reduce nasal morbidity without compromising surgical results and complication rates. There are, however, no data available on its results in endoscopic surgery (transsphenoidal surgery [TSS]) for pituitary adenoma.
The authors performed a cohort analysis of prospectively collected data on 144 patients (156 operations) undergoing TSS using the chopsticks technique with 3T intraoperative MRI. All patients had at least 3 months of postoperative neurosurgical, endocrinological, and rhinological follow-up (Sino-Nasal Outcome Test-20 [SNOT-20] and Sniffin' Sticks). The surgical technique is described, and the achieved gross-total resection (GTR) and extent of resection (EOR) together with patients' clinical outcomes and complications are descriptively reported.
On 3-month postoperative MRI, GTR was achieved in 71.2% of patients with a mean EOR of 96.7%. GTR was the surgical goal in 122 of 156 cases and was achieved in 106 of 122 (86.9%), with a mean EOR of 98.7% (median 100%, range 49%-100%). There was no surgical mortality. At a median follow-up of 15 months (range 3-70 months), there was 1 permanent neurological deficit. As of the last available follow-up, 11.5% of patients had a new pituitary single-axis deficit, whereas 26.3% had improvement in endocrinological function. Three patients had new postoperative hyposmia. One patient had severe impairment of sinonasal function (SNOT-20 score > 40). The operation resulted in endocrine remission in 81.1% of patients with secreting adenomas.
This study shows that the chopsticks technique confers resection and morbidity results that compare favorably with literature reports of TSS. This technique permits a single surgeon to perform effective endoscopic bimanual dissection through a single nostril, reducing manipulation of healthy tissue and thereby possibly minimizing surgical morbidity.
“筷子”技术是一种三器械、双手单鼻孔技术，最近已在神经内镜手术中引入。它允许由一名外科医生控制动态手术视野，同时保持双手分离。作为一种单鼻孔入路，它只需要对一个鼻腔的粘膜进行操作。该技术的原理是在不影响手术结果和并发症发生率的情况下减少鼻腔发病率。然而，在垂体腺瘤的内镜手术（经蝶窦手术[TSS]）中，尚无关于其结果的可用数据。
作者对 144 例（156 例手术）接受经蝶窦手术使用“筷子”技术并结合 3T 术中 MRI 的前瞻性收集数据进行了队列分析。所有患者均有至少 3 个月的术后神经外科、内分泌和鼻科随访（鼻-鼻窦炎结局测试 20 项[SNOT-20]和嗅棒测试）。描述了手术技术，并描述性报告了获得的大体全切除（GTR）和切除程度（EOR）以及患者的临床结果和并发症。
在术后 3 个月的 MRI 上，71.2%的患者达到 GTR，平均 EOR 为 96.7%。156 例中有 122 例（86.9%）的 GTR 是手术目标，其中 106 例（122 例中的 86.9%）达到了 GTR，平均 EOR 为 98.7%（中位数 100%，范围 49%-100%）。无手术死亡。在中位随访 15 个月（范围 3-70 个月）时，有 1 例永久性神经功能缺损。截至最后一次可获得的随访，11.5%的患者出现新的垂体单轴缺陷，而 26.3%的患者内分泌功能改善。3 例患者出现新的术后嗅觉减退。1 例患者有严重的鼻-鼻窦功能障碍（SNOT-20 评分>40）。手术使 81.1%的分泌性腺瘤患者达到内分泌缓解。
本研究表明，“筷子”技术可获得与经蝶窦手术文献报告相当的切除和发病率结果。该技术允许一名外科医生通过单个鼻孔进行有效的内镜双手分离，减少对健康组织的操作，从而可能最大限度地减少手术发病率。
