{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:04:08Z","timestamp":1792022648110,"version":"4.4.0"},"reference-count":72,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The \u201cchopsticks\u201d technique is a 3-instrument, 2-hand mononostril technique that has been recently introduced in endoscopic neurosurgery. It allows a dynamic surgical view controlled by one surgeon only while keeping bimanual dissection. Being a mononostril approach, it requires manipulation of the mucosa of one nasal cavity only. The rationale of the technique is to reduce nasal morbidity without compromising surgical results and complication rates. There are, however, no data available on its results in endoscopic surgery (transsphenoidal surgery [TSS]) for pituitary adenoma.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors performed a cohort analysis of prospectively collected data on 144 patients (156 operations) undergoing TSS using the chopsticks technique with 3T intraoperative MRI. All patients had at least 3 months of postoperative neurosurgical, endocrinological, and rhinological follow-up (Sino-Nasal Outcome Test\u201320 [SNOT-20] and Sniffin\u2019 Sticks). The surgical technique is described, and the achieved gross-total resection (GTR) and extent of resection (EOR) together with patients\u2019 clinical outcomes and complications are descriptively reported.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n On 3-month postoperative MRI, GTR was achieved in 71.2% of patients with a mean EOR of 96.7%. GTR was the surgical goal in 122 of 156 cases and was achieved in 106 of 122 (86.9%), with a mean EOR of 98.7% (median 100%, range 49%\u2013100%). There was no surgical mortality. At a median follow-up of 15 months (range 3\u201370 months), there was 1 permanent neurological deficit. As of the last available follow-up, 11.5% of patients had a new pituitary single-axis deficit, whereas 26.3% had improvement in endocrinological function. Three patients had new postoperative hyposmia. One patient had severe impairment of sinonasal function (SNOT-20 score > 40). The operation resulted in endocrine remission in 81.1% of patients with secreting adenomas.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n This study shows that the chopsticks technique confers resection and morbidity results that compare favorably with literature reports of TSS. This technique permits a single surgeon to perform effective endoscopic bimanual dissection through a single nostril, reducing manipulation of healthy tissue and thereby possibly minimizing surgical morbidity.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2020.3.focus2065","type":"journal-article","created":{"date-parts":[[2020,6,3]],"date-time":"2020-06-03T08:21:59Z","timestamp":1591172519000},"page":"E15","source":"Crossref","is-referenced-by-count":11,"title":["Assessing the surgical outcome of the \u201cchopsticks\u201d technique in endoscopic transsphenoidal adenoma surgery"],"prefix":"10.3171","volume":"48","author":[{"given":"Carlo","family":"Serra","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Clinical Neuroscience Center;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor E.","family":"Staartjes","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neuroscience Center;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolai","family":"Maldaner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neuroscience Center;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Holzmann","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael B.","family":"Soyka","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Gilone","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Universit\u00e0 degli Studi di Napoli \u201cFederico II,\u201d Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Schmid","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital of Z\u00fcrich, University of Z\u00fcrich, Switzerland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Tschopp","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Universit\u00e0 degli Studi di Napoli \u201cFederico II,\u201d Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Regli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neuroscience Center;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1576","DOI":"10.3171\/2017.12.JNS172318","article-title":"Complications associated with microscopic and endoscopic transsphenoidal pituitary surgery: experience of 1153 consecutive cases treated at a single tertiary care pituitary center","volume":"130","author":"Agam MS","year":"2019","unstructured":"Agam MS, Wedemeyer MA, Wrobel B, Weiss MH, Carmichael JD, Zada G: Complications associated with microscopic and endoscopic transsphenoidal pituitary surgery: experience of 1153 consecutive cases treated at a single tertiary care pituitary center. 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