Neuroendoscopic single-nostril nasoseptal approach for tuberculum sellae meningiomas: technical description and preliminary clinical experience.

OBJECTIVE

To describe the surgical technique and preliminary feasibility of neuroendoscopic resection of selected tuberculum sellae meningiomas through a single-nostril nasoseptal approach.

METHODS

Two female patients with small, centrally located tuberculum sellae meningiomas (13 × 11 × 10 mm and 16 × 11 × 12 mm) underwent tumor resection through a single-nostril nasoseptal approach. Neither tumor showed marked lateral extension, optic canal invasion, cavernous sinus involvement, or vascular encasement. A transseptal submucosal corridor was created through one nostril. A rigid nasal retractor was used in the first patient, whereas a soft-channel system was used in the second. Multilayer skull base reconstruction was performed using artificial materials.

RESULTS

Both procedures were completed through the planned unilateral corridor without conversion to a binostril or transcranial approach. Complete tumor removal was achieved in both patients based on intraoperative endoscopic inspection and early postoperative MRI. Pathology confirmed WHO grade 1 meningioma in both cases. Both patients reported postoperative visual improvement, and pituitary function remained normal without diabetes insipidus. The first patient developed transient postoperative cerebrospinal fluid rhinorrhea, which resolved with conservative management. The second patient had no postoperative cerebrospinal fluid leakage. Follow-up nasal endoscopy showed satisfactory mucosal healing without septal perforation, nasal adhesion, or apparent anatomical deformity.

CONCLUSION

The single-nostril nasoseptal approach may provide a feasible complementary endonasal corridor for carefully selected small, centrally located tuberculum sellae meningiomas. The soft-channel system may improve instrument maneuverability within the narrow operative space. However, this preliminary two-patient experience cannot establish the safety, efficacy, reproducibility, or superiority of this approach. Larger studies with longer follow-up and standardized functional assessments are needed.