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However, a large posterior septal perforation is inevitable. We routinely utilize a modified para\/transseptal approach using the combination of a Killian and a contralateral rescue flap incision (PTSA with K-R incision). Especially, rescue flap incision is used on ipsilateral side of the tumor extension to facilitate lateral expansion of the anterior sphenoidotomy and tumor resection. One hundred eighty-nine patients underwent EES using PTSA with K-R incision in Tsukuba university hospital. Gross total resection (GTR) was achieved in 146 (77.2%) patients. Even in cases of significant lateral tumor extension (Knosp 3 or 4), GTR was achieved in 56 of 90 (62.2%) patients. Among the 168 patients with available rhinological follow-up data, postoperative anterior and posterior septal perforation occurred in six (3.6%) and 18 (10.7%) patients, respectively. Surgical intervention was required in one (0.6%) patient with anterior septal perforation. Thus, PTSA with K-R incision was effective in preserving the nasal septal mucosa on one side and gaining a sufficient surgical corridor with lateral expansion of the anterior sphenoidotomy on the other side. Our strategy may be preferable to improve maneuverability of instruments during tumor resection.<\/jats:p>","DOI":"10.1038\/s41598-024-84334-y","type":"journal-article","created":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T09:56:51Z","timestamp":1736416611000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Endoscopic endonasal approach for pituitary neuroendocrine tumor with septal mucosa incision tailored to tumor extension intending unilateral septal mucosa preservation"],"prefix":"10.1038","volume":"15","author":[{"given":"Hiroyoshi","family":"Kino","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyoshi","family":"Akutsu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuho","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuma","family":"Hara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuke","family":"Morinaga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidetaka","family":"Miyamoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rieko","family":"Ii","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koutarou","family":"Osawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eiichi","family":"Ishikawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,1,9]]},"reference":[{"key":"84334_CR1","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.1007\/s00701-017-3193-1","volume":"159","author":"IA Al-Baldawi","year":"2017","unstructured":"Al-Baldawi, I. 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