Yellow enhance mode is useful for distinguishing tissues in endoscopic transnasal surgery: case series with preliminary results

Precise tissue differentiation is vital in neurosurgery, especially during endoscopic endonasal surgery (ETS), where visual information is critical. The Yellow Enhance (YE) mode, a novel image-enhanced endoscopy technology, emphasizes yellow pigments to potentially improve tissue differentiation. This study retrospectively evaluated the efficacy of YE mode in five cases (two primary pituitary neuroendocrine tumors, one recurrent skull base-invasive pituitary neuroendocrine tumor, one pituitary apoplexy, and one recurrent craniopharyngioma) using the Olympus VISERA ELITE III endoscope. Eight experienced neurosurgeons reviewed surgical videos and provided 40 structured evaluations. Statistical analyses (Kruskal-Wallis and Mann-Whitney U tests) compared scores among cases. Gross or near-total resection was achieved in all cases without neurological complications. YE mode improved differentiation between normal pituitary tissue and tumors in 80% of cases, but was less effective in cases like pituitary apoplexy with degenerative changes. Across 40 evaluations, 68% rated YE mode as "useful" or "somewhat useful," while 20% noted limited utility in complex cases, such as recurrent craniopharyngiomas. YE mode shows promise in enhancing visual differentiation during ETS, particularly for normal pituitary tissue, but its utility depends on tissue characteristics. Larger prospective studies are needed to validate these findings and explore broader applications in neurosurgery.