{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T03:40:29Z","timestamp":1791690029724,"version":"4.3.4"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2021,8,6]],"date-time":"2021-08-06T00:00:00Z","timestamp":1628208000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Keelung Chang Gung Memorial Hospital","award":["CMRPG2J0112"],"award-info":[{"award-number":["CMRPG2J0112"]}]},{"name":"Keelung Chang Gung Memorial Hospital","award":["CMRPG2J0102"],"award-info":[{"award-number":["CMRPG2J0102"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The endoscopic transsphenoidal approach is an efficient minimally invasive procedure for removal of pituitary tumors that can be accomplished through a one-hand or two-hand approach. The one-hand procedure through one nostril is more intuitive for surgeons, but maneuvering the instruments can be restrictive. The two-hand procedure using a one-and-half nostril approach provides more precise manipulation. This study aimed to compare the surgical outcomes of one-hand\/mono-nostril and two-hand\/one-and-half nostril surgeries for resection of large pituitary tumors by a single neurosurgeon.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>The surgical data of 78 consecutive cases with pituitary macroadenoma (diameter &gt;1 cm) were reviewed retrospectively. Altogether, 30 cases received one-hand\/mono-nostril surgery, while 48 cases received two-hand\/one-and-half nostril surgery. Postoperative outcomes of the two operations were compared.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The operative time, hospital stay, residual rate of pituitary macroadenoma, visual field, surgical complications, and re-operative rates were slightly improved in the two-hand\/one-and-half nostril surgery group compared with that in the one-hand\/mono-nostril surgery group (all <jats:italic>p<\/jats:italic>&gt;0.05). However, postoperative hypopituitarism was less frequent (1\/48; 2.0%) with the two-hand\/one-and-half nostril approach than with the mono-nostril approach (<jats:italic>p<\/jats:italic> = 0.004). Similar surgical outcomes were found in all patients with either small or large pituitary tumors, except that the difference in postoperative improvement in visual field change reached statistical significance (<jats:italic>p<\/jats:italic> = 0.044).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>A single-surgeon endoscopic endonasal transsphenoidal surgery with two-hand\/one-and-half nostril approach is an effective and safe procedure for removal of large pituitary tumors.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0255599","type":"journal-article","created":{"date-parts":[[2021,8,6]],"date-time":"2021-08-06T17:25:07Z","timestamp":1628270707000},"page":"e0255599","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["Endoscopic transsphenoidal surgery for resection of pituitary macroadenoma: A retrospective study"],"prefix":"10.1371","volume":"16","author":[{"given":"Jiun-Lin","family":"Yan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen-Nen","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8163-9871","authenticated-orcid":true,"given":"Pin-Yuan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,8,6]]},"reference":[{"issue":"1","key":"pone.0255599.ref001","doi-asserted-by":"crossref","first-page":"44","DOI":"10.3171\/jns.1997.87.1.0044","article-title":"Endoscopic endonasal transsphenoidal surgery: experience with 50 patients","volume":"87","author":"HD Jho","year":"1997","journal-title":"J Neurosurg"},{"issue":"1","key":"pone.0255599.ref002","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.3171\/foc.2005.19.1.8","article-title":"Endoneurosurgical hemostasis techniques: lessons learned from 400 cases","volume":"19","author":"A Kassam","year":"2005","journal-title":"Neurosurg Focus"},{"issue":"6 Suppl","key":"pone.0255599.ref003","doi-asserted-by":"crossref","first-page":"S152","DOI":"10.1016\/j.wneu.2014.07.035","article-title":"The transition from microscopic to endoscopic transsphenoidal surgery: the experience at Brigham and Women\u2019s Hospital","volume":"82","author":"ER Laws","year":"2014","journal-title":"World Neurosurg"},{"issue":"4","key":"pone.0255599.ref004","doi-asserted-by":"crossref","first-page":"151","DOI":"10.2176\/nmc.ra.2016-0276","article-title":"Recent Evolution of Endoscopic Endonasal Surgery for Treatment of Pituitary Adenomas","volume":"57","author":"H Nishioka","year":"2017","journal-title":"Neurol Med Chir (Tokyo)"},{"issue":"5","key":"pone.0255599.ref005","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1227\/01.neu.0000325861.06832.06","article-title":"Endoscopic cranial base surgery: classification of operative approaches","volume":"62","author":"TH Schwartz","year":"2008","journal-title":"Neurosurgery"},{"issue":"2","key":"pone.0255599.ref006","doi-asserted-by":"crossref","first-page":"334","DOI":"10.3171\/2015.6.JNS142637","article-title":"Binostril versus mononostril approaches in endoscopic transsphenoidal pituitary surgery: clinical evaluation and cadaver study","volume":"125","author":"J Conrad","year":"2016","journal-title":"J Neurosurg"},{"issue":"12","key":"pone.0255599.ref007","doi-asserted-by":"crossref","first-page":"2360","DOI":"10.1002\/lary.21153","article-title":"Middle turbinectomy for exposure in endoscopic endonasal transsphenoidal surgery: when is it necessary?","volume":"120","author":"B Guthikonda","year":"2010","journal-title":"Laryngoscope"},{"issue":"9","key":"pone.0255599.ref008","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1007\/s00701-013-1788-8","article-title":"Endoscopic endonasal trans-sphenoidal approach for pituitary adenomas: is one nostril enough?","volume":"155","author":"S Han","year":"2013","journal-title":"Acta Neurochir (Wien)"},{"issue":"6","key":"pone.0255599.ref009","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1080\/02688697.2016.1199786","article-title":"Learning curve for the transsphenoidal endoscopic endonasal approach to pituitary tumors","volume":"30","author":"T Qureshi","year":"2016","journal-title":"Br J Neurosurg"},{"key":"pone.0255599.ref010","doi-asserted-by":"crossref","first-page":"618 e7","DOI":"10.1016\/j.wneu.2016.08.044","article-title":"Expanded Endonasal Endoscopic Approach for Resection of an Infrasellar Craniopharyngioma","volume":"95","author":"H Abou-Al-Shaar","year":"2016","journal-title":"World Neurosurg."},{"issue":"1","key":"pone.0255599.ref011","first-page":"E3","article-title":"Expanded endonasal approach: the rostrocaudal axis. 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