Impairment of Olfaction and Mucociliary Clearance After Expanded Endonasal Approach Using Vascularized Septal Flap Reconstruction for Skull Base Tumors

Abstract

EEA but not TTEA has a short-term (3 months) negative impact on patient's olfaction and mucociliary clearance. Patients should be informed about smell loss as a consequence of skull base surgery to prevent legal claims. Likewise, further research and some modifications on reconstruction flaps are encouraged to avoid damaging the olfactory neuroepithelium.

Postoperative Findings in Endoscopic Endonasal Surgery of The Skull Base

“…Rotenberg et al [21] observed that at 6 months post-surgery patients undergoing endoscopic endonasal hypophysectomy and nasoseptal flap reconstruction presented hyposmia according to the score obtained in the UPSIT. In our series of 50 patients undergoing ESBS, 36 with transsphenoidal surgery and 14 with extended surgery, we observed that patients undergoing extended approach and nasoseptal flap reconstruction had higher olfactory dysfunction at 3 months post-surgery compared to patients undergoing transsphenoidal surgery [2].…”

“…In one of the first studies about posterior nasal symptoms in skull base surgery, de Almenida et al [3] observed that the most frequent finding one month postoperative were nasal crusts (98%), and at least half of the patients continue with nasal crusts for 3 months post-surgery; the time of disappearance of the crusts was related to the complexity of the surgery but not to the use of fat or flaps to close the defect of the skull base. Recently, Alobid et al [2] studied a series of patients undergoing transsphenoidal ESBS (38 patients) or extended surgery with nasoseptal flap reconstruction (17 patients), they observed that in the postoperative period 28% of the patients who undergone transsphenoidal approaches and 64% who undergone extended surgery had posterior rhinorrhea. Graham et al [17] compared the nasal symptoms in patients undergoing endoscopic or open surgery, noting that patients in the endoscopic surgery group had a lower score of nasal symptoms.…”

“…Regarding to post-surgical quality of life Georgalas et al [6] have observed that the negative impact of the nasoseptal flap in the quality of life, is mainly due to an increased tendency to headaches and reduced smell, but improves over time especially in thosepatients with secreting pituitary tumors. Conversely, Alobid et al [2] found no differences between the groups of non functioning tumors and functioning pituitary tumors.…”

“…The progress and development of these endoscopic techniques are mainly due to the ever increasing knowledge of endoscopic anatomy, technological advances and the use of vascularized flaps for reconstruction of the skull base [1]. As in endoscopic sinus surgery the extended approaches can cause a series of postoperative morbidities, like crusting and posterior rhinorrhea, especially in those cases requiring a nasoseptal flap reconstruction [2,3]. All sinus surgery could cause a mechanical damage of the sinus mucosa, which would require a subsequent healing process.…”

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

“…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. 18 Kim et al described differing outcomes based on cold dissection versus electrocautery, 19 noting that olfactory impairment was uncommon and reported in only one patient with impairment in their series. The premise that thermal injury might contribute highlights the fact that a defined area of olfactory-bearing septal mucosa exists.…”