A comparison between collaborative and single surgeon approach in endoscopic endonasal surgery to sphenoid sinus

  • Mostafa IsmailEmail author
  • Ahmed A. Abdelaziz
  • Mohab Darwish



Endoscopic endonasal transsphenoidal surgery (EETS) requires abundant collaborative work between neurosurgeon and ear, nose, and throat (ENT) surgeon. In low-volume centers, however, the surgery may be carried out completely and solely by a neurosurgeon. The current study evaluates the differences in both technique and complications in the approach to the sphenoid sinus for endoscopic endonasal approach (EEA) performed solely by a single neurosurgeon compared to collaborative effort between neurosurgery and otolaryngology.


The study comprises 50 consecutive patients with intra-sellar pituitary lesions undergoing EETS. Half of the patients were operated completely by single neurosurgeon (group A) and the other half by collaboration between single ENT surgeon, as a primary surgeon during nasal step, and the neurosurgeon (group B). Both groups were assessed intra-operatively as to operative technique, average time of EEA to sphenoid sinus, and presence of endonasal structural difficulties and complications.


A significant difference was recorded between both groups regarding average time of EEA to sphenoid sinus (P < 0.001) and incidence of intraoperative nasal complications (P = 0.006). There was a difference between ENT surgeon and neurosurgeon adopting the same approach to sphenoid sinus. Sphenoid sinus approaches from group B characterized by their short duration (mean 10 vs 22 min) and low incidence of intraoperative endonasal complications (4.8% vs 28%).


Study results emphasized the necessity of collaboration between neurosurgeon and ENT surgeon in endoscopic endonasal approaches, to efficiently deal with intraoperative endonasal difficulties and complications which pose difference for both surgeons performing the same surgical procedure.


Endoscopic surgery Transsphenoidal approach Anatomical variants 



All authors declare that they did not receive any source of funding for this study.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of OtorhinolaryngologyMinia University HospitalMinyaEgypt
  2. 2.Department of NeurosurgeryMinia University HospitalMinyaEgypt

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