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.