{"id":662199,"date":"2026-03-30T10:31:37","date_gmt":"2026-03-30T08:31:37","guid":{"rendered":"https:\/\/www.neurochirurgie-lariboisiere.com\/?p=662199"},"modified":"2026-03-30T10:32:27","modified_gmt":"2026-03-30T08:32:27","slug":"a-new-minimally-invasive-concept-and-closure-technique-for-endoscopic-endonasal-approaches","status":"publish","type":"post","link":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/2026\/03\/30\/a-new-minimally-invasive-concept-and-closure-technique-for-endoscopic-endonasal-approaches\/","title":{"rendered":"a new minimally invasive concept and closure technique for endoscopic endonasal approaches"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"662199\" class=\"elementor elementor-662199 elementor-662182\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c47f191 e-flex e-con-boxed e-con e-parent\" data-id=\"c47f191\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;pix_scale_in&quot;:&quot;none&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-07c1f3f elementor-widget elementor-widget-text-editor\" data-id=\"07c1f3f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"adenome-page\">\n\n<div class=\"adenome-intro\">\nA new surgical technique developed by the neurosurgery team at Lariboisi\u00e8re Hospital, published in the <em>Journal of Neurosurgery<\/em> (2025), demonstrates that complex skull base tumors can be operated on <span class=\"mc\">through the nose<\/span> in an even less invasive way \u2014 while preserving patients&#8217; quality of life.\n<\/div>\n\n<section class=\"section-block\">\n<h3>The challenge: operating through the nose without damaging it<\/h3>\n\n<p>Endoscopic endonasal surgery is now the gold standard for reaching deep skull base tumors \u2014 chordomas, craniopharyngiomas, meningiomas \u2014 <strong>without opening the skull<\/strong>, by passing directly through the nasal cavities.<\/p>\n\n<p>However, this approach has long required removing certain nasal structures to widen the working corridor, and harvesting a <strong>nasoseptal flap<\/strong> \u2014 a vascularized mucosal pedicle used to reconstruct the skull base at the end of the procedure. While this technique represented a major advancement, it can leave lasting nasal side effects: crusting, dryness, obstruction, and olfactory disturbances.<\/p>\n<\/section>\n\n<section class=\"section-block\">\n<h3>The solution: navigating around obstacles rather than removing them<\/h3>\n\n<p>The team led by Pr S\u00e9bastien Froelich and Dr Thibault Passeri developed an alternative approach based on two combined innovations:<\/p>\n\n<ul class=\"traitements-list\">\n  <li><strong>The mononostril chopsticks technique:<\/strong> the endoscope and suction are held in a single hand like chopsticks, freeing the other hand for the surgical instrument. This configuration allows working in a confined space <strong>without removing nasal structures<\/strong>, using angled endoscopes to navigate around corners rather than cutting them away.<\/li>\n  <li><strong>Sphenoid sinus cranialization with septal mucosa suturing:<\/strong> at the end of the procedure, instead of using a nasoseptal flap, the nasal mucosa is simply <strong>sutured<\/strong> like a skin incision. The cavity left by the tumor is filled with fat, and skull base reconstruction is achieved without sacrificing the nasoseptal mucosa.<\/li>\n<\/ul>\n<\/section>\n\n<section class=\"section-block\">\n<h3>The study: 82 patients, compelling results<\/h3>\n\n<p>The team compared <strong>82 consecutive patients<\/strong> who underwent surgery for paraclival and craniovertebral junction lesions:<\/p>\n\n<div class=\"types-grid\">\n  <div class=\"type-card\">\n    <h4>New technique group (SSCT)<\/h4>\n    41 patients operated using the chopsticks mononostril approach with sphenoid sinus cranialization and septal mucosa suturing.\n  <\/div>\n  <div class=\"type-card\">\n    <h4>Traditional technique group (NSFT)<\/h4>\n    41 patients previously operated using the extended endoscopic endonasal approach with the nasoseptal flap technique.\n  <\/div>\n<\/div>\n\n<p>Both groups were broadly comparable in terms of demographic characteristics. The most common tumor was <strong>skull base chordoma<\/strong> (70.7% in the SSCT group vs 58.5% in the NSFT group), followed by chondrosarcomas, craniopharyngiomas, and meningiomas.<\/p>\n<\/section>\n\n<section class=\"section-block\">\n<h3>Results: equally effective, better tolerated<\/h3>\n\n<ul class=\"traitements-list\">\n  <li><strong>Equivalent surgical efficacy:<\/strong> gross-total or subtotal resection was achieved in <span class=\"mc\">97.6% of patients<\/span> in the SSCT group compared to 85.4% in the traditional group \u2014 a non-significant difference, confirming that the new technique is non-inferior in terms of oncological outcomes.<\/li>\n  <li><strong>Comparable CSF leak risk:<\/strong> 12.2% in the SSCT group vs 9.8% in the traditional group \u2014 no significant difference between the two groups.<\/li>\n  <li><strong>Significantly improved quality of life:<\/strong> patients in the SSCT group reported significantly better overall scores (p = 0.004) on the EES-Q questionnaire dedicated to quality of life after endonasal surgery, with improvements in both the physical (p &lt; 0.001) and psychological (p = 0.006) domains.<\/li>\n<\/ul>\n<\/section>\n\n<section class=\"section-block\">\n<h3>What this means for patients<\/h3>\n\n<p>This study confirms that complex, deep skull base tumors can be removed <strong>without sacrificing nasal anatomy<\/strong>, with improved postoperative recovery and a lower impact on daily life. For patients with chordomas, craniopharyngiomas, or skull base meningiomas, this technique represents a <span class=\"mc\">concrete advancement<\/span> in terms of postoperative comfort.<\/p>\n\n<p>These results are part of a broader approach championed by the Lariboisi\u00e8re team: improving tumor control while <strong>preserving quality of life<\/strong> \u2014 two goals that are no longer mutually exclusive.<\/p>\n<\/section>\n\n<section class=\"section-block\">\n<h3>Reference<\/h3>\n\n<ol class=\"publications-list\">\n  <li><span class=\"pub-authors\">Passeri T, Alc\u00e2ntara T, Fava A, Watanabe N, Jiang T, Justo J, Vu TH, Bernat A-L, Abbritti R, Baussart B, Chainey J, Froelich S.<\/span>\n  Chopsticks mononostril approach with sphenoid sinus cranialization and septal mucosa suturing: a new minimally invasive concept and closure technique for endoscopic endonasal approaches.\n  <em>Journal of Neurosurgery.<\/em> 2025. doi:10.3171\/2025.8.JNS251403.\n  <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/41825064\/\" target=\"_blank\" rel=\"noopener\">View on PubMed \u27a4<\/a><\/li>\n<\/ol>\n<\/section>\n\n<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>A new surgical technique developed by the neurosurgery team at Lariboisi\u00e8re Hospital, published in the Journal of Neurosurgery (2025), demonstrates that complex skull base tumors can be operated on through the nose in an even less invasive way \u2014 while&#8230;<\/p>\n","protected":false},"author":5,"featured_media":10127,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[152,1],"tags":[],"class_list":["post-662199","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-neurosurgery","category-research"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/posts\/662199","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/comments?post=662199"}],"version-history":[{"count":7,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/posts\/662199\/revisions"}],"predecessor-version":[{"id":662208,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/posts\/662199\/revisions\/662208"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/media\/10127"}],"wp:attachment":[{"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/media?parent=662199"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/categories?post=662199"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/tags?post=662199"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}