Mono-nostril endoscopic transsphenoidal surgery in management of pituitary neuroendocrine tumor: a single center experience

The mono-nostril technique in endoscopic transsphenoidal surgery (ETSS) has gained attention for the management of pituitary neuroendocrine tumors. However, the technique offers a narrow working space, which may lead to challenges and complications. This retrospective cross-sectional study aims to report the outcomes of mono-nostril ETSS in 29 patients affected with pituitary neuroendocrine tumors. The study included individuals with surgically manageable pituitary tumors that had exhibited inadequate responses to conservative treatment. Patients were excluded if the tumor showed complete encasement of the internal carotid artery from all sides, if the tumor exhibited complete bilateral invasion of the cavernous sinus, and when the tumor displayed complete bilateral invasion of the optic nerve, especially if the patient was unwilling to undergo surgery due to the risk of ophthalmoplegia or color blindness. In 48.3% of the cases, the tumors invaded adjacent structures, including the suprasellar region, cavernous sinus, and carotid artery. The surgery was through the transsellar approach in 51.7% of cases, while 44.8% required both transsellar and suprasellar approaches. Complete tumor resection was achieved in 96.6% of cases, with three cases (10.3%) necessitating pituitary gland removal. The mean duration of operations was 2.5 ± 0.5 hours, and the mean hospital stay was 4 ± 1 days. The most prevalent complications were intercavernous sinus connection injury (31%), temporary diabetes insipidus (27.6%), and cavernous sinus injury (27.6%). Vision disturbance in affected cases was improved. No recurrence was reported. The mono-nostril approach in ETSS may be a viable alternative with minimal intraoperative and postoperative complications.