Expanded Endonasal Approach using Vascularized Septal Flap Reconstruction for Skull Base Tumors has a Negative Impact on Sinonasal Symptoms and Quality of Life

Alobid, Isam; Enseñat, Joaquim; Mariño‐Sánchez, Franklin; Rioja, Elena Castellano; Notaris, Matteo de; Mullol, Joaquim; Bernal‐Sprekelsen, Manuel

doi:10.2500/ajra.2013.27.3932

Cited by 52 publications

(36 citation statements)

References 48 publications

(65 reference statements)

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“…Several questionnaires and tools have been introduced and used in clinical studies of endoscopic skull base surgery to assess QoL morbidity and sinonasal outcomes. These include Short Form-36 (SF-36), Anterior Skull Base Questionnaire (ASBQ), Rhinosinusitis Outcome Measure (RSOM)-31, Sinonasal Outcome Test (SNOT)-20, SNOT-22, and many others [6,7,24,26,[28][29][30][31][32][33]. However, due to several different questionnaires and no standardized definition for QoL, it is hard to compare different studies.…”

Section: Quality Of Life (Qol)mentioning

confidence: 98%

Sinonasal morbidity following endoscopic endonasal skull base surgery

Awad

Mohyeldin

El‐Sayed

et al. 2015

Clinical Neurology and Neurosurgery

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Section: Quality Of Life (Qol)mentioning

confidence: 98%

Sinonasal morbidity following endoscopic endonasal skull base surgery

Awad

Mohyeldin

El‐Sayed

et al. 2015

Clinical Neurology and Neurosurgery

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“…20 Other studies have reported transient impairment of mucociliary clearance time and subjective olfaction after nasoseptal flap reconstruction, although the clinical significance of those findings is not clear and similar impairment has been reported after pituitary surgery without flap reconstruction. 1,2 Similarly, the presence of a donor site for harvesting autologous graft material is not associated with worse postoperative QOL. Taken together, these findings illustrate that skull base reconstruction considerations should not prevent surgeons from applying the endoscopic approach for pituitary resection and that harvesting and using a nasoseptal flap in large tumors, where a significant CSF leak is expected, is a well-tolerated procedure.…”

mentioning

confidence: 99%

Preservation of multidimensional quality of life after endoscopic pituitary adenoma resection

McCoul

Bedrosian

Akselrod

et al. 2015

JNS

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T he endoscopic endonasal transsphenoidal approach to the pituitary gland is gaining popularity as an alternative to traditional microscope-assisted techniques. Although still a matter of debate, the endoscopic approach appears to be superior to the microscopic technique with regard to extent of resection, specifically for macroadenomas, 5,12,18 and also offers benefits for nasal function and morbidity. 5,20,21 Increased rates of resection can be explained by the improved visualization offered by the endoscope, which is advanced into the nasal cavity to provide a wide panoramic view and a lateral view through the use of straight and angled scopes. Morbidity is theoretically decreased by preserving nasal mucosa, opening the sinuses to permit drainage, avoiding superficial mucosal incisions, and eliminating use of the retractor. 5,18,20,21 However, controversy remains regarding sinonasal morbidity abbreviatioNs ASBQ = Anterior Skull Base Questionnaire; GH = growth hormone; GTR = gross-total resection; IGF-1 = insulin-like growth factor-1; QOL = quality of life; SNOT-22 = 22-Item Sino-Nasal Outcome Test; STR = subtotal resection. submitted March 13, 2014. accepted November 12, 2014. iNclude wheN citiNg Published online June 5, 2015; DOI: 10.3171/2014.11.JNS14559. disclosure The authors report no conflict of interest concerning the material or methods used in this study or the findings specified in this paper. Dr. Schwartz has stock options in Visionsense. . This study aims to assess the effect of endoscopic pituitary adenoma resection on site-specific and sinonasal-related QOL before and after endoscopic surgery using validated instruments. methods Consecutive adult patients undergoing endoscopic endonasal resection of pituitary adenoma were prospectively enrolled from a single tertiary care center. All patients completed the Anterior Skull Base Questionnaire (ASBQ) and the 22-Item Sino-Nasal Outcome Test (SNOT-22) preoperatively and then at regular intervals after surgery to assess their perceived QOL with regard to hormonal, surgical, and anatomical factors. results Eighty-one of 114 patients were eligible for study; median follow-up was 16 months. This cohort included 24 (29.6%) nonsecreting macroadenomas and 57 (70.4%) hypersecreting tumors. There was significant improvement in the mean ASBQ score at 12 weeks, 6 months, and 1 year after surgery (p < 0.05), while postoperative SNOT-22 scores, at the same time points, showed no significant difference from preoperative scores. Both ASBQ and SNOT-22 scores showed transient worsening at 3 weeks postoperatively. Subtotal resection correlated with worse QOL, both overall and among patients with hypersecreting tumors (p < 0.05). Extrasellar tumor extension, intraoperative CSF leakage, and a reconstruction technique during surgery did not impact postoperative QOL. Visual disturbances did not significantly alter QOL. There were no postoperative CSF leaks in this series. coNclusioNs Endoscopic resection of pituitary adenoma is associated with long-term improvements in sit...

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“…1,6 Ultimately, this mucosal trauma is dictated by differences in surgical technique, even among procedures described under the umbrella term endonasal endoscopic approach" However, the design of the nasoseptal flap has not been well addressed, and it is likely that heterogeneous practices exist. Authors have suggested modifications to the technique, 1,17 and the data presented in this study provide evidence that preservation of the olfactory strip as a discrete area can avoid significant impact on both olfaction and sinonasal function. Although the concept of an olfactory strip was promoted by colleagues (e.g., Ric Carrau) for many years and alluded to in publications, 21 the focus was usually on septal mucosal recovery.…”

Section: Discussionmentioning

confidence: 57%

“…Some controversy has arisen regarding the morbidity of nasoseptal flaps, with some groups reporting significant disturbance in smell. 3,17 The techniques used in these studies may not have preserved the olfactory area as described in this study. Comparison with studies reporting expanded techniques that intentionally transverse the posterior cribriform area do not allow a good comparison of olfactory disturbance because the olfactory morbidity is anticipated as a result of this approach.…”

Section: Discussionmentioning

confidence: 94%

The Olfactory Strip and Its Preservation in Endoscopic Pituitary Surgery Maintains Smell and Sinonasal Function

et al. 2015

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).Differing outcomes on olfaction have been reported from transsphenoidal approaches. [1][2][3][4] In general, patients prefer the endoscopic approach, 5 and olfactory scores are better after the endoscopic route. 6 The nasoseptal flap, in particular, to reconstruct the skull base as part of the overall process has been implicated in smell dysfunction. However, much of the literature on the impact of the nasoseptal flap comes from extended skull base surgery. In our institution, utilizing a small modified nasoseptal flap during simple pituitary surgery has greatly improved our reconstructive options and access. However, controversy exists as to the additional morbidity of utilizing such an approach. The existing studies on patients with large skull base tumors are not an appropriate population to discuss the impact of surgery or

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Expanded Endonasal Approach using Vascularized Septal Flap Reconstruction for Skull Base Tumors has a Negative Impact on Sinonasal Symptoms and Quality of Life

Abstract: The EEA with VSF produces more sinonasal symptoms than pituitary surgery, surgery for skull base and pituitary tumors has negative impact on QoL, and functioning tumors have no further negative effect on sinonasal symptoms and QoL.

Cited by 52 publications

References 48 publications

Sinonasal morbidity following endoscopic endonasal skull base surgery

Sinonasal morbidity following endoscopic endonasal skull base surgery

Preservation of multidimensional quality of life after endoscopic pituitary adenoma resection

The Olfactory Strip and Its Preservation in Endoscopic Pituitary Surgery Maintains Smell and Sinonasal Function

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