Pituitary Endoscopic Surgery: The Mononostril, Two-Hands Three-Instruments Technique with High Field 3-Tesla MRI

Aims: To present the surgical results of the three instruments, two-hands, one nostril technique (3-2-1) with the combined use of intraoperative high field 3-Tesla (3T-ioMR) imaging in endoscopic pituitary surgery (TSS).

Methods: We reviewed clinical and radiological data from our prospective patients’ database of those patients who underwent TSS with the 3-2-1. With the 3-2-1, the operating surgeon holds in the left hand the endoscope and the suction leaving the right hand free for bimanual dissection within a clean surgical field. No mechanical arm is used, guaranteeing in this way a continuously adaptable surgical view.

Results: One hundred eighteen patients were operated on with the 3-2-1 technique. Three months follow-up was available for 112. Gross total resection was the surgical goal in 90 patients and was achieved in 82 (91%) allowing for an average extent of resection of 99.6%. There was no surgical mortality. Three patients needed surgical revision because of cerebrospinal fluid leak. Two patients experienced postoperative epistaxis. At last follow-up, one patient had a permanent neurologic deficit (visual acuity defect). Of the 95 patients with pre- and postoperative rhinologic evaluation, no patient experienced a severe impairment of nasal quality of life (corresponding to a SNOT test > 40 points). Two patients only experienced new postoperative hyposmia (defined as Sniffin test <9/12).

Conclusions: The 3-2-1 technique with 3T-ioMR allowed in our hands excellent resection results at no adjunctive morbidity. It offers the possibility to minimize surgical invasiveness without renouncing to dynamic bimanual dissection technique.

No conflict of interest has been declared by the author(s).