A clinical series evaluating a modified binostril endoscopic endonasal approach designed to preserve nasal mucosa while maintaining bimanual surgical freedom.

Donofrio, Bertazzoni, Riccio, Prevedello, Tubbs, Fioravanti and colleagues report 81 patients with sellar and suprasellar lesions treated through a mucosa-sparing binostril corridor combined with an algorithm-based reconstruction strategy.

Gross-total resection was achieved in 72.9% of cases. Intraoperative CSF leak occurred in 59.3%, while the postoperative CSF leak rate was 2.5%. Reconstruction was tailored to intraoperative risk, ranging from free mucosal grafts to modified gasket-seal techniques.

The authors also assessed sinonasal outcomes, showing that more complex reconstruction was associated with worse postoperative SNOT-22 scores.

Why it matters

This paper is particularly relevant for teams aiming to balance endonasal access, mucosal preservation and reconstruction reliability. The low postoperative CSF leak rate is encouraging, although the absence of a direct control group limits conclusions about superiority over standard binostril techniques.

Reference

Donofrio CA, Bertazzoni G, Riccio L, Prevedello D, Tubbs RS, Fioravanti A, et al.
The Modified Sparing Binostril Endoscopic Endonasal Approach Combined With an Algorithm-Based Reconstruction Strategy: Surgical and Functional Outcomes in Sellar and Suprasellar Lesions.
Operative Neurosurgery. Published October 6, 2026.
DOI: 10.1227/ons.0000000000002214
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