Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, 90095, USA.
Clin Neurol Neurosurg. 2021 Mar;202:106499. doi: 10.1016/j.clineuro.2021.106499. Epub 2021 Jan 15.
A transnasal transsphenoidal (TNTS) approach can be performed through a binostril or mononostril technique. The binostril technique is generally preferred, however the mononostril may be an underutilized approach with significant benefits.
All (n = 521) pituitary adenoma transsphenoidal surgeries performed from March 2008 until July 2017 at a university hospital in Indonesia were isolated. The majority (n = 512) were performed through a mononostril approach with no nasal speculum by a single experienced neurosurgeon. A PubMed literature review researching the differences in indications, techniques, and outcomes for both approaches supplements the case series. The mononostril surgical technique is described in detail.
The average mononostril operating time was 105 min. The most prevalent surgical complications were CSF leak (4.1 %), diabetes insipidus (3.7 %) and cacosmia (2.1 %). Visual field deficits noted in 85 %, 89 % improved. Length of stay was less than 2 days for 90 %, with 13 ICU admissions (average one day). Recurrence rate was 8.2 % at follow up (1-10 years).
Based on a literature review, binostril TNTS surgeries have longer operative time and a higher risk of epistaxis. According to our experience, post-operative patient comfort and satisfaction are higher with the monostril approach. Furthermore, this technique is easier to teach, ENT assistance unnecessary, and thus especially advantageous in low resource settings. Our CSF leak and tumor recurrence rates were lower than reported binostril rates in the literature. The mononostril technique is both safe and effective and should be strongly considered for an appropriately pre-selected subset of pituitary adenomas.
经鼻蝶窦（TNTS）入路可通过双鼻孔或单鼻孔技术进行。一般来说，双鼻孔技术更为常用，但单鼻孔技术可能是一种被低估的方法，具有显著的优势。
从 2008 年 3 月至 2017 年 7 月，在印度尼西亚的一家大学医院，对所有（n=521）垂体腺瘤经蝶窦手术进行了分离。大多数（n=512）手术通过单鼻孔入路由一位经验丰富的神经外科医生单枪匹马完成，没有使用鼻镜。通过对 PubMed 文献的回顾，研究了两种方法的适应证、技术和结果的差异，补充了病例系列。详细描述了单鼻孔手术技术。
平均单鼻孔手术时间为 105 分钟。最常见的手术并发症是脑脊液漏（4.1%）、尿崩症（3.7%）和嗅觉障碍（2.1%）。85%的视野缺损患者有记录，89%的患者得到改善。90%的患者住院时间少于 2 天，13 例患者入住 ICU（平均一天）。在随访（1-10 年）时，复发率为 8.2%。
根据文献回顾，双鼻孔 TNTS 手术的手术时间更长，且鼻出血的风险更高。根据我们的经验，单鼻孔入路术后患者的舒适度和满意度更高。此外，这种技术更容易教授，不需要耳鼻喉科的协助，因此在资源有限的情况下特别有利。我们的脑脊液漏和肿瘤复发率低于文献报道的双鼻孔技术。单鼻孔技术既安全又有效，对于适当选择的垂体腺瘤亚组应强烈考虑。
