Endoscopic Modified Transseptal Transsphenoidal Approach for Maximal Preservation of Sinonasal Quality of Life and Olfaction

Hong, Sang Duk; Nam, Do‐Hyun; Kong, Doo‐Sik; Kim, Hyo Yeol; Chung, Seung‐Kyu; Dhong, Hun‐Jong

doi:10.1016/j.wneu.2015.12.050

Cited by 49 publications

(49 citation statements)

References 20 publications

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“…reported a similar outcome in a patient who had an olfactory groove meningioma. The same can be accomplished through a transseptal approach, which Hong et al . reports as being associated with better olfaction and QOL outcomes compared to a standard transnasal approach.…”

Section: Complicationsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

143

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Section: Complicationsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

143

279

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“…All patients were extubated after the end of surgery and prior to being transferred to the post-anesthesia care unit (PACU). All surgeries were performed by a single neurosurgeon [1].…”

Section: Interventions and Intraoperative Managementmentioning

confidence: 99%

“…The endoscopic transnasal transseptal transsphenoidal approach (TSA) is commonly used for the excision of pituitary tumors [1]. This surgical approach enables improved visualization of the sellar and parasellar areas, but is associated with an increase in intraoperative stress responses due to intense noxious stimuli at various stages of the surgery, including the insertion of epinephrine-soaked nasal packing, nasal speculum insertion, sphenoidal drilling, and sellar dissection, induce a variety of stress responses [2].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative dexmedetomidine attenuates norepinephrine levels in patients undergoing transsphenoidal surgery: a randomized, placebo-controlled trial

Kang

Jeong

et al. 2020

BMC Anesthesiol

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Background: Dexmedetomidine has sympatholytic effects. We investigated whether dexmedetomidine could attenuate stress responses in patients undergoing endoscopic transnasal transseptal transsphenoidal surgery. Methods: Forty-six patients were randomized to receive a continuous infusion of 0.9% saline (n = 23) or dexmedetomidine (n = 23). Immediately after general anesthesia induction, the dexmedetomidine group received a loading dose of 1 mcg/kg dexmedetomidine over 10 min, followed by a maintenance dose of 0.2-0.7 mcg/kg/h and the control group received 0.9% saline at the same volume until 30 min before the end of surgery. Serum levels of epinephrine, norepinephrine, and glucose were assessed before surgery (T1) and the end of drug infusion (T2). The primary outcome was the change in norepinephrine levels between the two time points. Results: Changes (T2-T1 values) in perioperative serum norepinephrine levels were significantly greater in the dexmedetomidine group than in the control group (median difference, 56.9 pg/dL; 95% confidence interval, 20.7 to 83.8 pg/dL; P = 0.002). However, epinephrine level changes did not show significant intergroup differences (P = 0.208). Significantly fewer patients in the dexmedetomidine group than in the control group required rescue analgesics at the recovery area (4.3% vs. 30.4%, P = 0.047). Conclusions: Intraoperative dexmedetomidine administration reduced norepinephrine release and rescue analgesic requirement. Dexmedetomidine might be used as an anesthetic adjuvant in patients undergoing transnasal transseptal transsphenoidal surgery.

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“…All endonasal procedures were performed by one rhinologist with a 4‐mm, 0° or 45° endoscope using a bilateral rescue flap procedure or modified transseptal approach . During surgery, the bilateral inferior, middle, and superior turbinates were gently lateralized and saved.…”

Section: Methodsmentioning

confidence: 99%

Quality of life after extended versus transsellar endoscopic skull base surgery from 767 patients

et al. 2018

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Objectives/Hypothesis The aim of this study was to compare sinonasal‐related quality of life (QOL) in patients treated by extended or transsellar endoscopic skull base surgery. Study Design Prospective data analysis. Methods Prospectively collected data from patients who underwent endoscopic skull base surgery between 2012 and 2017 were analyzed. Primary outcomes were preoperative Sino‐Nasal Outcome Test‐20 (SNOT‐20) scores and then 1‐month, 3‐month, and 6‐month follow‐up. Comparative analysis was performed between the endoscopic transsellar approach (ETA) group (n = 647) and an extended endoscopic endonasal approach (EEEA) group (n = 120). In ETA group, the SNOT‐20 score was compared between patients with a nasoseptal flap (NSF) (ETA‐NSF) and without an NSF (ETA‐no NSF). Results The mean total SNOT‐20 score was significantly worse in the EEEA than ETA group at 1, 3, and 6 months postoperatively (P < .05). Although there was no significant difference in total SNOT‐20 score between the ETA‐NSF and ETA‐no NSF group at 3 and 6 months after surgery, the percentage of patients with significant change (≥0.8) in the SNOT‐20 score was higher in the NSF used group at 1, 3, and 6 months postoperatively (22.92% vs. 13.51%, P = .029; 20.59% vs. 5.59%, P = .039; and 24.00% vs. 4.03%, P = .003, respectively). According to multivariate analysis conducted regarding factors that deteriorate sinonasal QOL at 6 months following surgery, only NSF usage is significantly associated with poor outcome (odds ratio: 4.371, P = .011) Conclusions Sinonasal‐related QOL was significantly worse in patients treated by the EEEA versus ETA. Use of an NSF is the only poor prognostic factor in sinonasal QOL after endoscopic skull base surgery. Level of Evidence 2b Laryngoscope, 129:1318–1324, 2019

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Endoscopic Modified Transseptal Transsphenoidal Approach for Maximal Preservation of Sinonasal Quality of Life and Olfaction

Cited by 49 publications

References 20 publications

ICAR: endoscopic skull‐base surgery

ICAR: endoscopic skull‐base surgery

Intraoperative dexmedetomidine attenuates norepinephrine levels in patients undergoing transsphenoidal surgery: a randomized, placebo-controlled trial

Quality of life after extended versus transsellar endoscopic skull base surgery from 767 patients

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