• World Neurosurg · Sep 2024

    Combined Endonasal and Trans-septal approach to Achieve Binostril Access in Endoscopic Skull Base Approaches to Minimise Nasal Morbidity: A technical note.

    • Amandeep Kumar.
    • Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India. Electronic address: amanjagdevan@gmail.com.
    • World Neurosurg. 2024 Sep 12; 192: 117123117-123.

    BackgroundFeasibility and safety of endoscopic endonasal approaches have become well established, and focus has now shifted to minimizing nasal morbidity. To this end, several modifications in the nasal stage have been described that focus primarily on preservation of nasal mucosa on right side of the nasal cavity. However, nasal mucosal preservation on the left side of the nasal cavity has largely been ignored. This technical note describes a modified technique that can eliminate mucosal damage in the left nasal cavity.MethodsA transseptal approach is used on the left, and an endonasal approach is used on the right side. A hemitransfixion incision is used to raise the left submucosal tunnel. The mucosa of the tunnel lies laterally in apposition with the lateral nasal wall, thereby protecting it from injury by repeated passage of instruments. When the tunnel mucosa is pushed back medially, the left nasal cavity appears absolutely normal without any evidence of mucosal damage.ResultsCombined endonasal and transseptal technique for the nasal stage was performed in 51 patients with sellar/suprasellar lesions. Nonfunctional pituitary adenomas were the most common pathology (macroadenomas: n = 14; giant adenomas: n = 10) followed by functional adenomas (acromegaly: n = 10; prolactinomas: n = 3; Cushing disease: n = 1), craniopharyngiomas (n = 6), clival tumors (n = 5), and tuberculum sellae meningiomas (n = 2).ConclusionsA combination of endonasal and transseptal approaches uses the advantages of both endoscopic and microscopic approaches sans the disadvantage of restricted space seen in microscopic approaches. It makes the binostril approach least disruptive to the left nasal mucosa and thus can reduce overall morbidity of endoscopic endonasal approaches.Copyright © 2024 Elsevier Inc. All rights reserved.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…