Endoscopic One-Nostril Transseptal Transsphenoidal Approach for Pituitary Tumors: Back to the Past—A Multi-Center Preliminary Experience and Literature Review

TL;DR

This paper introduces a new minimally invasive surgical technique for pituitary tumors that reduces nasal complications while maintaining effectiveness.

Contribution

The study presents the Endoscopic One-Nostril Transseptal Transsphenoidal Approach (EONOTTA) as a novel alternative to traditional pituitary tumor surgery.

Findings

EONOTTA achieved comparable tumor resection rates to traditional methods with fewer nasal complications.

At one-year follow-up, no tumor recurrence was observed in the 40 patients studied.

Patients reported improved quality of life and functional outcomes post-surgery.

Abstract

This study presents the Endoscopic One-Nostril Transseptal Transsphenoidal Approach (EONOTTA) as a minimally invasive surgical technique for selected cases of pituitary macroadenomas. Derived from the classic endoscopic endonasal approach, EONOTTA allows excellent exposure of the sellar region while preserving nasal mucosa and olfactory function. The technique offers comparable disease control to standard endoscopic endonasal approaches, with reduced sinonasal morbidity and postoperative discomfort. Despite limitations such as retrospective design and small sample size, findings support EONOTTA as a safe, efficient alternative for non-extended pituitary tumors requiring limited surgical exposure.

Objective: Endoscopic endonasal transsphenoidal pituitary surgery is a diffuse and well-established surgical technique: over the years, the transseptal approach via a nasal mucosal incision has also gained popularity. Here we describe our preliminary experience with an entirely endoscopic one-nostril transseptal transsphenoidal approach (EONOTTA) for pituitary sellar tumor resection; the surgical corridor runs through the entire length of the nasal septum via an incision in the nasal mucosa. Methods: A total of 40 patients with a midline prevalent pituitary tumor who underwent EONOTTA from January 2022 to June 2023 were retrospectively reviewed for the evaluation of the safety and efficacy of this technique. Results: At 1 year follow-up, all patients had no recurrence, and the degree of tumor resection was comparable to that of the control group undergoing the traditional endoscopic endonasal approach. A low rate of nasal and post-surgical complications occurred; globally, EONOTTA was not time-consuming, and a better functional result was noticed, with a better quality of life for patients. Conclusions: This study confirms, in our preliminary experience, the EONOTTA’s excellent risk–benefit ratio in selected cases; for an experienced multidisciplinary team, it provides a good maneuverability and a functional outcome while preserving the integrity of the nasal mucosa.

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