INTRODUCTION
Transsphenoidal adenomectomy (TSA) has evolved enormously and is the
most frequently performed skull base surgery
nowadays.1 The endoscopic endonasal approach (EEA) has
become a popular surgical method for TSA because of its excellent
visualization and minimal comorbidities. Since EEA is a mature and
established surgical approach with minimal complications, researchers
have recently turned their focus on preserving nasal function and
quality of life.
Many otolaryngologists wonder whether rhinological outcome can be
altered by choosing different surgical corridors for TSA, which are
classified according to the routes of sphenoidotomy.2The most common route of sphenoidotomy is transnasal, namely dissection
directly from the bilateral sphenoidoethmoidal recess in the nasal
cavity. Although it seems straightforward, it inevitably damages the
anterior wall of the sphenoid sinus, the posterior nasal septum, and
their overlying mucosa. In contrast, transseptal sphenoidotomy, defined
as dissection through the subperichondrial and subperiosteal planes of
the nasal septum, preserves the nasal mucosa and restores the integrity
of the sphenoid sinus and posterior nasal septum. The transseptal
approach, via either the endonasal or the sublabial route, was once the
state-of-the-art surgical method performed in microscopic
TSA.3 Recently, several groups have undertaken efforts
to develop endoscopic endonasal transseptal TSA and have reported
promising rhinological results.4-8 Endoscopic
endonasal transseptal TSA should receive more attention during the
coronavirus disease 2019 (COVID-19) pandemic because the integrity of
the sphenoid sinus provents unexpected injuries from common nasal
procedures, such as nasopharyngeal swab test or nasogastric tube
placement,9, 10 for the rest of their lives.
However, endoscopic endonasal transseptal TSA might be questioned due to
the limitations of the maneuverability and exposure. Several studies
have reported solely the neurosurgical outcomes,4, 5while no studies have compared rhinological and neurosurgical outcomes
concurrently to delineate the tradeoff. Therefore, we conducted this
study to investigate whether the transseptal approach for endoscopic
endonasal TSA could prevent nasal morbidities without compromising
neurosurgical outcomes.