Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2026
Chopsticks mononostril endoscopic endonasal approach for adult Craniopharyngioma: A retrospective comparative cohort study.
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Deng Xuehai, Li Gaowei, Zhou Liangxue, He Jiaojiang
Аннотация
OBJECTIVE: To assess the technical feasibility of the mononostril chopsticks endoscopic endonasal approach for adult craniopharyngioma and to evaluate 3-month outcomes relative to the binostril cohort.
METHODS: We retrospectively analyzed 107 adult patients with pathologically confirmed craniopharyngioma and available 3-month follow-up data who underwent endoscopic endonasal surgery at West China Hospital. Patients treated with the mononostril chopsticks technique between February 2025 and February 2026 comprised the mononostril cohort (n = 51), whereas those treated with the conventional binostril approach between February 2024 and February 2025 comprised the binostril cohort (n = 56). Research assistants who were not informed of the surgical approach administered the questionnaires. Three-month questionnaires were completed face-to-face during outpatient follow-up, whereas preoperative scores were obtained retrospectively by telephone interview. The primary outcome was the EES-Q total score at 3 months. Secondary outcomes included SNOT-22 and VAS scores, perioperative outcomes, extent of resection, visual and endocrine outcomes, and complications.
RESULTS: Baseline characteristics were similar between treatment periods. Operative time did not differ significantly after adjustment (adjusted mean difference, -14.33 min; 95% CI, -33.87 to 5.21; P = 0.149), whereas hospital stay was shorter during the mononostril period (-1.25 days; 95% CI, -2.07 to - 0.43; P = 0.003). Gross-total resection rates were 82.4% and 71.4%, respectively (adjusted odds ratio, 2.27; 95% CI, 0.86 to 6.01; P = 0.098). No statistically significant differences were detected in the adjusted visual or overall-complication analyses; endocrine outcomes were summarized descriptively because valid at-risk denominators were unavailable. Adjusted EES-Q total and SNOT-22 scores were lower during the mononostril period, with differences of - 9.39 and - 8.57 points, respectively (both P < 0.001). Selected VAS and EES-Q domain outcomes also remained significant after false-discovery-rate correction. Wide confidence intervals precluded conclusions of equivalence.
CONCLUSION: The mononostril chopsticks technique was technically feasible in the included patients. Treatment during the mononostril period was associated with lower baseline-adjusted 3-month patient-reported symptom scores. However, these associations cannot be separated from treatment-era effects and should not be interpreted as evidence of superiority or causality.
METHODS: We retrospectively analyzed 107 adult patients with pathologically confirmed craniopharyngioma and available 3-month follow-up data who underwent endoscopic endonasal surgery at West China Hospital. Patients treated with the mononostril chopsticks technique between February 2025 and February 2026 comprised the mononostril cohort (n = 51), whereas those treated with the conventional binostril approach between February 2024 and February 2025 comprised the binostril cohort (n = 56). Research assistants who were not informed of the surgical approach administered the questionnaires. Three-month questionnaires were completed face-to-face during outpatient follow-up, whereas preoperative scores were obtained retrospectively by telephone interview. The primary outcome was the EES-Q total score at 3 months. Secondary outcomes included SNOT-22 and VAS scores, perioperative outcomes, extent of resection, visual and endocrine outcomes, and complications.
RESULTS: Baseline characteristics were similar between treatment periods. Operative time did not differ significantly after adjustment (adjusted mean difference, -14.33 min; 95% CI, -33.87 to 5.21; P = 0.149), whereas hospital stay was shorter during the mononostril period (-1.25 days; 95% CI, -2.07 to - 0.43; P = 0.003). Gross-total resection rates were 82.4% and 71.4%, respectively (adjusted odds ratio, 2.27; 95% CI, 0.86 to 6.01; P = 0.098). No statistically significant differences were detected in the adjusted visual or overall-complication analyses; endocrine outcomes were summarized descriptively because valid at-risk denominators were unavailable. Adjusted EES-Q total and SNOT-22 scores were lower during the mononostril period, with differences of - 9.39 and - 8.57 points, respectively (both P < 0.001). Selected VAS and EES-Q domain outcomes also remained significant after false-discovery-rate correction. Wide confidence intervals precluded conclusions of equivalence.
CONCLUSION: The mononostril chopsticks technique was technically feasible in the included patients. Treatment during the mononostril period was associated with lower baseline-adjusted 3-month patient-reported symptom scores. However, these associations cannot be separated from treatment-era effects and should not be interpreted as evidence of superiority or causality.