Endoscopic Binostril versus Transnasal Transseptal Microscopic Pituitary Surgery: Sinonasal Quality of Life and Olfactory Function

Hong, Sang Duk; Nam, Do Hyun; Seol, Ho Jun; Choi, Na-Young; Kim, Hyo Yeol; Chung, Seung Kyu; Dhong, Hun Jong

doi:10.2500/ajra.2015.29.4165

Cited by 48 publications

(50 citation statements)

References 11 publications

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“…Endoscopic cases had a better rhinological outcome. Hong et al compared outcomes of patients undergoing unilateral microscopic and bilateral endoscopic surgery using the ASK nasal inventory, a derivative of the recently introduced ASK Nasal‐12; microsurgical cases showed better scores 3 months after surgery . Here, a further follow‐up would be necessary.…”

Section: Discussionmentioning

confidence: 79%

“…Hong et al compared outcomes of patients undergoing unilateral microscopic and bilateral endoscopic surgery using the ASK nasal inventory, a derivative of the recently introduced ASK Nasal-12; microsurgical cases showed better scores 3 months after surgery. [17][18][19] Here, a further follow-up would be necessary. In another comparative study of microscopical and bilateral endoscopical surgery, Pledger et al found no significant difference between the late postoperative SNOT-20 scores.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic unilateral transethmoid‐paraseptal approach to the central skull base

Eördögh

Briner

Simmen

et al. 2017

Laryngoscope Investig Oto

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ObjectivesThe endoscopic technique in transnasal skull base surgery offers optimal visualization and free manipulation in the surgical field. However, it may cause approach‐related sinonasal injury, influencing patients' quality of life (QOL). To minimize rhinological morbidity without restrictions in surgical manipulation and tumor resection, we introduced the unilateral transethmoidal‐paraseptal approach. In this article, we analyzed the long‐term results and sinonasal outcome of this technique.Study DesignRetrospective analysis of medical records.MethodsForty‐two consecutive patients underwent surgery between June 2010 and March 2014 using the transethmoid‐paraseptal approach. Perioperative work‐up included neurological, radiological, endocrinological, ophthalmological, and rhinological analysis. Patients' preoperative, 1‐month and 1‐year postoperative QOL was measured using the Sino‐Nasal Outcome Test (SNOT‐22).ResultsAt all individuals, a unilateral transethmoid‐paraseptal approach was performed. Removal of the turbinates, posterior septal resection or a conversion to biportal surgery could be avoided in all cases. There were no intraoperative neurovascular complications. All patients had a notable improvement in any disease‐related symptoms, as well as by objective criteria. Complete tumor resection was aimed in 39 cases and achieved in 31 of them. The SNOT‐22 scores transiently worsened 1 month after surgery and non‐significantly improved after 1 year, compared with the preoperative status. A subgroup of 7 patients with preoperative sinonasal disease evidence showed continuous significant improvement (p < .05) of SNOT‐22 scores across time. The smell screening tests showed no significant difference across time.ConclusionThe described approach allows safe removal of various skull base lesions without deterioration in sinonasal QOL and smell function.Level of Evidence4.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Endoscopic unilateral transethmoid‐paraseptal approach to the central skull base

Eördögh

Briner

Simmen

et al. 2017

Laryngoscope Investig Oto

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“…This approach offers improved illumination and superior panoramic visualization of the sella and the surrounding structures [3–5]. Compared with traditional sublabial or transseptal microscopic approach, ETSS offers minimal invasiveness, fewer complications, and overall improved outcomes [6, 7]. Traditionally, there are two approaches to endoscopic transsphenoidal surgery for pituitary adenomas: the two nostrils (binostril) approach and the one nostril (mononostril) approach [8, 9].…”

Section: Introductionmentioning

confidence: 99%

“…Obviously, there are increased risks of rhinological complications and postoperative discomfort. Recent studies have shown that BETA presents poor early-postoperative sinonasal QOL and a significant olfactory alteration [6, 11, 12]. Many cases reported better results using the mononostril approach [13, 14].…”

Section: Introductionmentioning

confidence: 99%

One-and-a-half nostril endoscopic transsphenoidal approach for pituitary adenomas—a technical report

Wen

Tang

Zhong

et al. 2016

J of Otolaryngol - Head & Neck Surg

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BackgroundBinostril endoscopic transsphenoidal approach (BETA) provides sufficient manipulation space and wide endoscopic vision, although it increases the trauma of nose. Mononostril endoscopic transsphenoidal approach (META) has minimal trauma of nose, at the expense of space within the operation. We describe a one-and-a-half nostril endoscopic transsphenoidal approach (OETA) that combines the advantages of BETA and META.MethodsWe introduced OETA for pituitary adenomas with a detailed technical description. A retrospective analysis was also performed on 57 consecutive patients who underwent one-and-a-half nostril endoscopic transsphenoidal surgery between March 2014 and June 2015 at Jinling hospital.ResultsThe gross total resection rate was 79%. The gross complete resection rate of Knosp grade 3 tumors were 63.6, and 27.3% in grade 4 tumors. Postoperative hormone remission was achieved in 14 out of 18 (77.8%) patients with secreting adenomas. Postoperative abnormal visual function improvement was achieved in 23 out of 32 patients (73%) with preoperative visual dysfunction. The overall intra-operative CSF leak was 17.5%, with the postoperative CSF leak decreased to 3.5% after the sellar reconstruction with the unilateral “rescue” nasoseptal flap procedure. The main sinonasal complaints 2 weeks after surgery were: loss of sense of smell (28%), decrease in sense of taste (4%), trouble breathing during the day (18%), thick nasal discharge (36%), post nasal discharge (8%), dried nasal material (6%), and headache (6%). Three months after surgery, there were no reports of decrease of taste, post nasal discharge, or dried nasal material. Other complaints were decreased significantly. Six months after surgery, the main complaints of sinonasal quality of life were negligible, and overall health status was near complete recovery to preoperative status.ConclusionsThe one-and-a-half nostril endoscopic transsphenoidal approach for pituitary adenomas is a simple and reliable technique. It provides not only a sufficient surgical corridor for a 2-surgeon/4 or 3-hands technique, but also ensures minimal invasion of the nasal canal.

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“…Chung et al 15 reports that CT-assisted surgery is associated with lower CSF leak rates compared to no image guidance or MRassisted procedures; the authors recognize the limitation of this report was the inability to control for the severity or extent of the disease. Hong et al 16 studied olfactory function and quality of life in patients undergoing endoscopic binostril or transnasal transseptal microscopic pituitary surgery. They report that transnasal transseptal surgery is associated with better postoperative quality of life and similar olfactory function when compared with the endoscopic approach.…”

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confidence: 99%

Advancing the Field of Rhinology and Allergy

Rank

2015

Am J Rhinol�Allergy

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The May/June issue of the American Journal of Rhinology & Allergy contains several articles that advance the field of rhinology and allergy. This editorial will provide a high level summary of the articles contained in this issue-be sure to examine the articles in more depth on the following pages.Several studies in this issue focus on the pathophysiology of airway inflammation. Wang et al 1 studied the regulation of aquaporin-5, a channel protein important for fluid secretion in allergic inflammation. They tested the 4 concentrations of histamine on the expression of aquaporin-5 in human nasal epithelial cells, findings a dose dependent decrease in expression. They further discovered that the downregulation of aquaporin by histamine occurs via inhibition of the cyclic adenosine monophosphate-responsive element binding protein. Choi et al 2 found that Asian sand dust, generated from the deserts in China, are capable of inducing MUCH8 and MUC5b expression via TLR-4 dependent signaling pathways. These findings were derived from experiments using human nasal epithelial cells. Asian sand dust may be an important environmental trigger for TLR-4 pathway expression and subsequent promotion of airway inflammation. Lam et al 3 used sinus mucosal samples to demonstrate increased IL-25 and IL-33 expression, but not TSLP expression, in patients with chronic rhinosinusitis, nasal polyps, and Ͼ10 eosinophils/high power field, in a comparison study with normal control tissue. Linke et al, 4 in another study using human samples, this time nasal polyps and inferior turbinate tissue, found that STAT5b, but not STAT5a, is activated compared to controls in patients with chronic rhinosinusitis and nasal polyps. Finally, Esmaeilzadeh et al 5 identified genetic variabilities of major histocompatibility complex class II for patients with aspirin exacerbated respiratory disease, suggesting a role for T cell activation in the pathophysiology of this disease process.One study focused on sinonasal tumor pathophysiology. Jung et al 6 studied expression of the Wnt signaling pathway to better understand the mechanism involved in the malignant transformation of sinonasal inverted papillomas. Their findings suggest several Wnt pathway signaling proteins, including ␤-catenin, cyclin D1, and Dvl-1, are associated with malignant transformation.Two studies analyzed imaging results as a means to better understand challenging diagnostic and management issues in rhinology. Craig and Goyal 7 analyzed images of patients who sustained sphenoid fractures and found that CSF leaks occurred in 9% and blunt carotid injury occurred in just 2% of sphenoid fractures. They also found a significant association between sphenoid roof fractures and CSF leak and that penetrating issues were strongly associated with CSF leak. Lin et al 8 describe the use of volumetric analysis for assessment of orbital volume in patients with chronic maxillary atelectasis, also called silent sinus syndrome. They concluded that expansion of maxillary sinus and decrease in orbit volume ca...

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Endoscopic Binostril versus Transnasal Transseptal Microscopic Pituitary Surgery: Sinonasal Quality of Life and Olfactory Function

Cited by 48 publications

References 11 publications

Endoscopic unilateral transethmoid‐paraseptal approach to the central skull base

Endoscopic unilateral transethmoid‐paraseptal approach to the central skull base

One-and-a-half nostril endoscopic transsphenoidal approach for pituitary adenomas—a technical report

Advancing the Field of Rhinology and Allergy

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