The one-nostril transnasal transsphenoidal extramucosal approach: The analysis of surgical technique and complications in 529 consecutive cases

The goal of this article was to evaluate the surgical technique and complications in 529 consecutive cases of the sellar area defects operated on through the one-nostril transsphenoidal approach over the last 10 years. There were 305 (58%) male patients and 224 (42%) female patients, aged from 14 to 90 years (mean 48 years). The patient is placed supine and the surgeon sits behind the patient's head. The microscope is placed above the head perpendicular to the C-arm of the x-ray intensifier. The speculum is introduced through the right nostril directly to the sphenoid rostrum. The nasal mucosa is coagulated at the septal insertion on the sphenoid rostrum, and the septum is pushed aside as a single mucoperichondral flap. The 2 mucosae are dissected on both sides of the sphenoid sinus and pushed aside by the tips of the speculum. Until the opening of the sphenoid sinus, the approach takes an average of 5 minutes. The duration of whole surgery was 35 to 125 minutes (mean 65 minutes). The 529 cases included 461 pituitary adenomas (including 43 reoperations), and 68 cases of other sellar defects. Eighteen different complications were analyzed and compared with a recent American National Survey. Our technique is compared with other approaches and positions. The role of an endoscope and navigation is evaluated. The one-nostril transsphenoidal approach is simpler, safer, and less time consuming than other types of transsphenoidal approaches.