Guanti bianchi technique for resection of selected pituitary adenomas

Since the introduction of the endoscopic endonasal approach (EEA) to skull base, the nasal phase has been a true challenge as it represents the moment of definition of the corridor, thus defining the instruments maneuverability at tumor removal phase. The longstanding cooperation between ENT and neurosurgeons have provided the possibility of creating adequate corridor with maximal respect toward nasal structures and mucosa. This sparked the idea of entering the sella as thieves, so we named “Guanti Bianchi” technique a lesser invasive variation of the approach for the removal of selected pituitary adenoma. The purpose of this study is to present the preliminary results of “Guanti Bianchi” technique. Data from 17 patients undergoing “Guanti Bianchi” technique (out of 235 standard EEA) at our center, were retrospectively analysed. ASK Nasal-12, a quality-of-life instrument developed specifically to assess patient perception of nasal morbidity, was administered pre- and postoperatively. 10 (59%) patients were men and 7 (41%) women. The mean age was 67.7 (range 35-88). The average duration of the surgical procedure was 71.17 minutes (range 45-100). GTR was achieved in all patients, no postoperative complications were observed. Baseline ASK Nasal-12 was near normal in all patients, 3/17 (17,6%) experienced transitory very mild symptoms without any worsening at 3 and 6 months. This minimally invasive technique does not require turbinectomy or carving of the nasoseptal flap, it alters the nasal mucosa as little as necessary, and it is quick and easy to perform. •The nasal phase represents a crucial step of the endoscopic endonasal approach to skull base, as it defines the surgical corridor and thus the instruments maneuverability.•“Guanti Bianchi” technique is a lesser invasive variation of the endoscopic endonasal approach in selected cases.•This minimally invasive technique alters the nasal mucosa as little as necessary, and it is quick and easy to perform.