comparing mononostril, binostril, and one and a half nostril endoscopic transsphenoidal approach for treating pituitary adenoma pituitary adenoma

Background and aim: eeta (endoscopic endonasal transsphenoidal approach) is a preferred choicefor pituitary tumors. eeta offers minimal invasiveness, fewer complications, and better outcomesthan the sublabial or transseptal microscopic approach. eeta has three approaches: mononostrilendoscopic transsphenoidal approach, binostril endoscopic transsphenoidal approach, andone and a half nostril approach. this study aims to compare three different eetas and comparebetween microscopic transsphenoidal approach, transcranial approach and eeta.methods and materials/patients: to provide up-to-date information, we concisely reviewedthese three eetas. using the keywords of “neuroendoscopy”, “meta” (mononostril endoscopictranssphenoidal approach), “oeta” (one and a half nostril approach), “beta” (binostril endoscopictranssphenoidal approach), “pituitary adenoma”, “eeta”, “endoscopy”, “transsphenoidalapproach”, “transcranial approach for pituitary adenoma” and “microscopic transsphenoidalapproach”. we retrieved all the relevant articles from google scholar, pubmed, and medline. then,we reviewed them and critically analyzed them.results: in beta there is free and easy movement of surgical instruments in the surgical fieldand a broader view of the sphenoid sinus and it is an excellent approach to resect large tumors.the meta is suitable in tumors with limited involvement of the intra-sellar and supra-sellar area.the mononostril approach is not suitable and has some limitations for the following situations:a crowded narrow nasal cavity, a harder tumor with the invasive appearance or significantsuprasellar extension, and lesions other than pituitary adenomas. the oeta provides a sufficientsurgical corridor for a 2-surgeon/4 or 3-hands technique with a minimal injury of the nose and goodoperative results, free and easy movement of surgical instruments in the surgical field, low postoperativemorbidity, and good post-operative quality of life.conclusion: in eeta, knowing the size and consistency of tumor, general versus invasive pituitaryadenoma, and the extent of parasellar and suprasellar extension, is essential. if we cannot reacha pituitary macroadenoma with a trans-sphenoidal approach, then we can use a transcranialapproach for the removal of the tumor. the microscopic transsphenoidal approach is suitable forpediatric pituitary adenoma.