One-and-a-Half Nostril versus Binostril Endoscopic Transsphenoidal Approach to the Pituitary Adenomas: Improved Sinonasal Quality of Life and Outcomes of the Prospective Clinical Trial

Background: Binostril endoscopic transsphenoidal approach (BETA) is the most common used surgery for pituitary adenoma and is very efficient for eradicating the lesions. Most patients have a good prognosis while its damage to nasal cavity and postoperative olfactory dysfunction remain controversial. With refinement of modern surgery, more attention should be paid to patients’ quality of life and preserving the function of olfactory after skull base surgery. Hence, we introduced the one-and-a-half nostril endoscopic transsphenoidal approach (OETA) in 2016 (shown in Table 1) which provided minimal invasion to the nasal cavity with expectation of improving patients’ quality of life postoperatively and registered a prospective randomized controlled clinical trial to assess this approach.

Methods: Sixty patients diagnosed as the pituitary adenoma preoperatively by imaging and serum hormone levels were randomly divided into the one-and-a-half nostril approach group (OETA, n = 29) and binostril approach group (BETA, n = 31). Additionally, the questionnaire Anterior Skull Base Nasal Inventory-12 (ASK Nasal-12) was distributed to participants to evaluate their nasal condition at 5 due time point (preoperative, 2-week postoperative, 1-month postoperative, 3-month postoperative, 6-month postoperative). We also compared tumor resection rate, hormonal remission rate, neurological complications and nasal outcomes between OETA and BETA. Each patient was followed up to 6 months postoperatively to observe their clinical outcomes.

Results: There was no difference in tumor resection rate, hormonal remission rate and the incidence rate of hypopituitarism, postoperative CSF leak, occasional diabetes insipidus, intracranial infection between OETA and BETA. In terms to nasal condition, patients in OETA group complained less about dried nasal material compared with BETA (p = 0.017) at 2-week point and presented better recovery of olfaction (p = 0.019) at 1-month point. Furthermore, two patients suffered from nasal bleeding in the long term in BETA while none occurred in OETA.

Conclusion: OETA achieved the same clinical outcomes as BETA and it’s worth noting that the patients in OETA group had a better clinical recovery of nasal function than those in BETA group and thus patients’ postoperative sinonasal quality of life was improved.

Fig. 1 (A) Sagittal view of OETA. (B) Coronal view of OETA. One-and-a-half approach: the unilateral septal mucosa was required incising for a “rescue” nasoseptal flap and the contralateral mucosa just needed ∼2 cm incision. It preserved contralateral septal olfactory strip and the vascular pedicles of sphenopalatine.