gms | German Medical Science

Objective: The transsphenoidal approach to sellar tumors has evolved enormously since its first description in the early 20^th century. Within the last two decades, endoscopic surgical strategies have become an integral part of the surgical armamentarium. The aim of this study is to distinguish between the mononostril and binostril approach in a clinical study as well as a cadaver study.

Methods: In the clinical part of the study 20 patients were operated in every group. Using the binostril approach we manipulated through both nasal cavities without using nasal retractor, in the mononostril approach we used one nasal cavity and nasal retractor. The cadaver study includes 5 cadavers each group, before and after preparation CCT-scans with coronar, sagittal und axial reconstruction were performed.

Results: Visual disturbances, hormone status, size of adenoma und CSF leak intraoperatively or postoperatively were comparable in both groups in the clinical study. In binostril group operation time was longer (123±40 vs. 93±28 min.), in the monostril group we had anatomical limitations caused by nasal retractor in 25% and damages at the ostia in 10% of cases. The cadaver study showed no significant difference between both techniques in preparation time. The nasal retractor in mononostril technique occurred the maneuverability of instruments, binostril technique led to a wider opening of the sphenoid sinus (craniocaudal 17.4 vs. 14.9 mm and bilateral 18.1 vs. 11.1 mm) resulting in an excellent panoramic view. In the nose and sphenoid sinus 0°-optic was excellent, but in the sella we preferred 30°-optic.

Conclusions: The monostril technique with shorter operation time has advantages in small adenomas, but in cases of macroadenomas und above all extended approaches the binostril technique with a great overview about anatomical structures should be preferred. Angled optics are very helpful.