Evaluation of olfactory function in patients undergoing endoscopic skull base surgery with nasoseptal flap

Carvalho, Ana Carolina Mayor de; Dolci, Ricardo Landini Lutaif; Rickli, Jeniffer Cristina Kozechen; Tateno, Daniela Akemi; Garcia, Davi Sousa; Encinas, Williams Escalante; Santos, Américo Rubens Leite dos; Lazarini, Paulo Roberto

doi:10.1016/j.bjorl.2020.03.006

Cited by 10 publications

(29 citation statements)

References 26 publications

(29 reference statements)

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“…If lacking, the median, range, and sample size were used to estimate the mean and variance (20) . We assumed that the median was equal to the mean Finally, 26 studies (3,(5)(6)(7)(11)(12)(13)(14)(15)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42) (6 retrospective, 18 prospective, and 2 RCTs) met the eligibility criteria and were included in this review. The characteristics of the studies are summarized in Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic transnasal access to the skull base requires the removal and disruption of structures containing olfactory neuroepithelium (11)(12)(13)(14)(15) . The nasoseptal flap (NSF), used in the reconstruction of the skull base defect, can aggravate this reduction in olfaction because its construction requires manipulation of the olfactory neuroepithelium or regions close to it (14) .…”

Section: Introductionmentioning

confidence: 99%

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Olfaction after endoscopic surgery for sellar and parasellar disease: an updated systematic review and meta-analysis

Lee

et al. 2022

Rhin

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Background: Whether endoscopic surgery for sellar/parasellar disease causes significant deficits in olfactory function remains unclear. We aimed to systematically review the olfactory outcomes in such settings based on the evidence up to date. Methods: PubMed, EMBASE, and CENTRAL were searched through February 1, 2021. Included studies were limited to endoscopic surgery for sellar/parasellar disease with follow-up olfactory function measured by standardized olfactory testing methods or subjective assessment. The primary outcome was the change in olfactory function after surgery assessed by standardized olfactory testing methods. The secondary outcome was the change in subjective olfactory function. Random-effects model was used in obtaining combine effects. Study quality was assessed using the Newcastle–Ottawa scale. Sensitivity analysis was carried out using the leave-one-out approach, and publication bias was assessed using Egger’s test. Results: The results show no significant difference in olfaction assessed by standardized olfactory testing methods at 1–3 months post-surgery (880 patients in 16 studies) or at 6–12 months post-surgery (1320 patients in 16 studies) compared to pre-surgery, whereas a significantly lower subjective olfaction at 3 months was observed. In addition, the lack of significant change in olfaction as assessed by standardized olfactory testing methods was observed regardless of whether patients were treated with or without the nasoseptal flap (NSF) harvesting. Heterogeneity and publication bias were observed, whereas sensitivity analysis showed the meta-analysis results are robust. Conclusion: The findings of this updated systematic review and meta-analysis support the conclusion that endoscopic surgery for sellar and parasellar pathology may pose no greater risk of olfactory dysfunction. In addition, the current evidence does not support there is an increased risk of diminished olfaction among patients treated with NSF during surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Olfaction after endoscopic surgery for sellar and parasellar disease: an updated systematic review and meta-analysis

Lee

et al. 2022

Rhin

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“…27 de Carvalho et al evaluated olfactory loss in patients who underwent expanded endoscopic approach with partial middle turbinectomy and NSF reconstruction and they found that the deterioration in the sense of smell was transient up to 3 months. 28 Several studies utilized the SNOT-22 to evaluate QOL in patients operated for pituitary lesions. Pant et al examined the trend over time of postoperative SNOT-22 scores in patients after endonasal anterior skull base tumor extirpation (n ¼ 51), including pituitary gland lesions and reported a significant improvement in the SNOT-22 scores.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Evaluation of Quality of Life in Patients Undergoing Extended Endoscopic Endonasal Surgery for Benign Pituitary Gland Lesion

Neiderman

Wengier

Dominsky

et al. 2021

J Neurol Surg B Skull Base

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Introduction Endoscopic endonasal surgery (EES) has become the preferred approach for pituitary tumor resection. Nevertheless, research on quality of life related to pituitary adenoma surgery is scarce. Objective The aim of the study is to evaluate short-term quality of life in patients after endoscopic endonasal resection of pituitary tumors and to find predictors for poor quality of life (QOL) outcome. Materials and Methods A prospective cohort study was conducted, including all patients who underwent EES for pituitary tumors in a tertiary medical referral center. Recruited patients completed the Anterior Skull Base Disease-Specific QOL (ASBS-Q) questionnaire and the Sinonasal Outcome Test 22 (SNOT-22) questionnaire before surgery, 2 and 4 to 6 months after surgery. Demographic and clinical data was collected. Results Our study included 49 patients. The overall ASBS-Q scores significantly improved 4 to 6 months after surgery (4.46 vs. 4.2, p < 0.05). We found a significant improvement in QOL related to emotional state 2 months post surgery (4.41 vs. 3.87, p < 0.05), which became borderline significant 4 to 6 months post surgery. There was a significant improvement in pain (4.5 vs. 4.08, p < 0.05) and vitality (4.43 vs. 4.16, p < 0.05) domains 4 to 6 months post surgery. SNOT-22 scores did not change significantly postoperatively. Factors such as secreting and non-secreting tumors, tumor size, intraoperative cerebrospinal fluid leak, gross tumor resection, endocrine remission, and the use of nasoseptal flap reconstruction did not have a significant effect on QOL. Conclusion We found that patients after EES reported improved QOL 4 to 6 months post surgery. Specific improvement was noted in the QOL related to pain and vitality.

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“…7,8,16 Rates of anosmia or hyposmia after EEAs are variable within the literature, with long-term rates of olfactory morbidity reported between 24 and 36% after EEAs for TSM and PM. 7,[17][18][19] Olfactory dysfunction is also reported after established transcranial approaches to TSM and PM, after which 10 to 65% of patients can suffer with olfactory dysfunction. 20,21 However, descriptions of the evolution of olfaction following contemporary transcranial techniques are lacking within the current literature.…”

Section: Introductionmentioning

confidence: 99%

Olfactory Outcomes after Resection of Tuberculum Sella and Planum Sphenoidale Meningiomas via a Transcranial Approach

Ved

Hayhurst

2021

J Neurol Surg B Skull Base

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Objectives Controversy exists surrounding the optimal approaches to tuberculum sella meningioma (TSM) and planum meningioma (PM). Olfaction is infrequently considered within this context but is nonetheless an important quality of life measure. The evolution of olfactory outcomes following contemporary transcranial surgery remains unclear. This study reviews olfactory outcomes after supraorbital craniotomy for TSM or PM and defines temporal trends in its recovery. Study Design A prospective study of a patients who underwent a minimally invasive supraorbital craniotomy for TSM or PM was conducted at a single neurosurgical center. Participants & Main Outcome Measures All patients were questioned about olfaction at presentation 3 months postoperatively, 12 months postoperatively, and annually thereafter (median follow-up = 37 months). The olfactory status of patients was categorized as normosmia, anosmia, hyposmia, parosmia, (altered perception of odours), or phantosmia, (olfactory hallucinations). Results Twenty-two patients were included in the study analysis, (range = 27–76). Precisely, 3 months after surgery, seven patients had normal olfaction (32%). Six patients were anosmic, (27%) four hyposmic, (18%), three parosmic, (14%), and two were phantosmic (9%). At 1-year follow-up, almost half of patients (10; 48%) were normosmic, while two patients (9.5%) were anosmic. There were no further improvements in olfaction between 1 year and long-term follow-up. Conclusion Subfrontal transcranial approaches for TSM or PM appear to be associated with changes in olfaction that can improve with time; these improvements occur within the first year after surgery. Impacts upon olfaction should be considered when selecting a surgical approach and patients counseled appropriately.

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Evaluation of olfactory function in patients undergoing endoscopic skull base surgery with nasoseptal flap

Cited by 10 publications

References 26 publications

Olfaction after endoscopic surgery for sellar and parasellar disease: an updated systematic review and meta-analysis

Olfaction after endoscopic surgery for sellar and parasellar disease: an updated systematic review and meta-analysis

A Prospective Evaluation of Quality of Life in Patients Undergoing Extended Endoscopic Endonasal Surgery for Benign Pituitary Gland Lesion

Olfactory Outcomes after Resection of Tuberculum Sella and Planum Sphenoidale Meningiomas via a Transcranial Approach

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