Surgeons at Tsukuba University Hospital have developed innovative techniques for performing endoscopic surgeries on pituitary neuroendocrine tumors (PitNETs) with fewer complications, particularly focusing on nasal septal preservation.
The endoscopic endonasal approach (EEA) is now one of the standard methods for surgical interventions involving PitNETs. Traditionally, this approach resulted in significant posterior septal perforation. To combat this, the team employed the modified para/transseptal approach (PTSA) combined with both the Killian and contralateral rescue flap incision (K-R incision). This technique maintains the integrity of the septal mucosa on one side, which is not only beneficial for nasal function but also enhances surgical maneuvers.
Data from 189 patients who underwent EEA for PitNETs was analyzed, showing impressively high rates of gross total resection (GTR) at 77.2%. Remarkably, even among cases of significant lateral tumor extension, the resection rate remained substantial, achieving GTR in 62.2% of such cases.
Postoperative complications were minimal, with only 3.6% of patients experiencing anterior septal perforation and 10.7% suffering from posterior perforation, showcasing the efficacy of the K-R incision approach. This was dramatically less than the complications seen with traditional direct incision methods, where large posterior perforations were almost guaranteed.
Surgeons detail their methodology as they selected the side of the rescue flap incision to match the direction of lateral tumor extension, which also aided the resection process significantly. This thoughtful alignment not only improves access but greatly increases maneuverability within the surgical field.
Ensure successful outcomes; follow-ups were conducted using both magnetic resonance imaging (MRI) and flexible endoscopies. These assessments confirmed the extent of resection and monitored for any complications such as sinusitis or nasal obstruction. The results are promising, indicating the new method provides not just surgical benefits but also contributes to improved quality of life for patients post-surgery.
With such compelling outcomes, the research champions the PTSA with K-R incision as the preferable technique for tumor resection, especially for cases exhibiting lateral extensions. This novel surgical strategy enhances the patient experience by reducing complications typically associated with traditional surgery.
Looking forward, the findings suggest additional investigation may be necessary to continue refining surgical techniques and optimizing patient results. The study emphasizes the importance of interdisciplinary collaboration between neurosurgeons and otolaryngologists as they work toward the dual goals of effective tumor resection and preservation of nasal function.