Endoscopic unilateral transethmoid‐paraseptal approach to the central skull base

Abstract

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.

Anatomy of the sphenopalatine artery and its implications for transnasal neurosurgery

“…Lee et al (8) , 2002 (50 cadaveric sides) 76 22 2 Babin et al (2) , 2003 (20 cadaveric sides) 10 50 30 5 5…”

“…After injecting the maxillary artery with red coloured resin followed by careful non-enzymatic maceration on 60°C for 1-3 months, the skulls were dried resulting in vascular corrosion cast of the nasal cavity´s arterial system. These specimens (34 sides) underwent endoscopic phantom surgery using the unilateral combined transethmoid-paraseptal approach (2) . Here we simulated all circumstances of a real surgery (positioning of the head and the instruments, draping, etc.).…”

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

“…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.…”

“…A total of 1858 patients were enrolled (mean age, 37.5-65.8 years; % male, 16-76.5%. The olfactory function reported using standardized olfactory testing methods included UPSIT outcomes (8 studies (6,11,12,15,(25)(26)(27)32) ), CCSIT outcomes (8 studies (28)(29)(30)(36)(37)(38)(39)42) ), Sniffin's Sticks outcomes (5 studies (3,34,35,40,41) ), CCCRC outcomes (2 studies (5,13) ), SDOT outcomes (2 studies (7,33) ) and the BAST-24 identification test (1 study (31) ).…”

“…Sixteen of the 26 studies (3,(5)(6)(7)12,13,15,27,(31)(32)(33)(37)(38)(39)(40)(41) , including 1320 patients, provided numerical data for olfaction measured preoperatively and 6-12 months after surgery (Table 2, B). Substantial heterogeneity was observed (Q statistic = 290.09; I 2 = 98.83; P < 0.001).…”