Shifting Paradigm from Binostril to Uninostril Endonasal Endoscopic Management of Pituitary Adenomas

Introduction: Endoscopic endonasal approach (EEA) techniques are a more minimally invasive way of managing pituitary adenomas (PAs). Uninostril approach (UNEEA) avoids many drawbacks of binostril technique (BNEEA), reducing invasiveness of the procedure with nearly equivalent instrumentation ability and visualization of the sellar region. We describe our transition to UNEEA for these lesions. Methods: Total 20 consecutive PAs were resected with either UNEEA or BNEEA. All patients received preoperative MRI and pituitary hormone assessment. Postoperatively, all patients were screened for development of diabetes insipidus, and pituitary hormone dysfunction; new deficits were treated with hormone supplementation and followed up with an endocrinologist. Our technique is described and operative nuances discussed. Results: Patient outcomes were generally excellent. Tumor size, extension, hormone status, hospital stay, complications, symptom improvement, and clinical/radiologic follow-up are analyzed and presented. Conclusion: EEA provides several advantages over transnasal microsurgery, including decreased trauma to the nares and improved visualization of the sellar region, both of which lead to better patient outcomes. UNEEA avoids contralateral ethmoidectomy/posterior septectomy, and avoids trauma to the contralateral nares. Our results demonstrate that patients with PAs can be managed effectively through a UNEEA with overall perioperative complication rates at least equal to BNEEA.