Nasal Septum After Sublabial Transseptal Transsphenoidal Pituitary Surgery

Urquhart, Andrew C.; Bersalona, Fernando; Ejercito, Victor S.; Holt, James J.

doi:10.1016/s0194-5998(96)70138-9

Cited by 12 publications

(10 citation statements)

References 12 publications

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“…Reported rhinological complications include sinusitis, synechiae, anosmia, epistaxis, septal perforation, nasal congestion, and impaired mucociliary clearance; these complications can adversely affect patients' nasal functioning, satisfaction with surgery, and quality of life (QOL). 1,4,5,13,16,33,35 Microscopic transsphenoidal surgery is the current gold standard for treating pituitary lesions. Although many variations in technique are practiced, transsphenoidal surgery often involves a uninostril exposure maintained by a nasal speculum, with visualization provided by an operating microscope.…”

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confidence: 99%

Comparison of sinonasal quality of life and health status in patients undergoing microscopic and endoscopic transsphenoidal surgery for pituitary lesions: a prospective cohort study

Little

Kelly

Milligan

et al. 2015

JNS

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obJect Despite the widespread adoption of endoscopic transsphenoidal surgery for pituitary adenomas, the sinonasal quality of life (QOL) and health status in patients who have undergone this technique have not been compared with these findings in patients who have undergone the traditional direct uninostril microsurgical technique. In this study, the authors compared the sinonasal QOL and patient-reported health status after use of these 2 surgical techniques. methods The study design was a nonblinded prospective cohort study. Adult patients with sellar pathology and planned transsphenoidal surgery were screened at 4 pituitary centers in the US between October 2011 and August 2013. The primary end point of the study was postoperative patient-reported sinonasal QOL as measured by the Anterior Skull Base Nasal Inventory-12 (ASK Nasal-12). Supplementary end points included patient-reported health status estimated by the 8-Item Short Form Health Survey (SF-8) and EuroQol (EQ)-5D-5L instruments, and sinonasal complications. Patients were followed for 6 months after surgery. results A total of 301 patients were screened and 235 were enrolled in the study. Of these, 218 were analyzed (111 microsurgery patients, 107 endoscopic surgery patients). Demographic and tumor characteristics were similar between groups (p ≥ 0.12 for all comparisons). The most common complication in both groups was sinusitis (7% in the microsurgery group, 13% in the endoscopic surgery group; p = 0.15). Patients treated with the endoscopic technique were more likely to have postoperative nasal debridements (p < 0.001). The ASK Nasal-12 and SF-8 scores worsened substantially for both groups at 2 weeks after surgery, but then returned to baseline at 3 months. At 3 months after surgery, patients treated with endoscopy reported statistically better sinonasal QOL compared with patients treated using the microscopic technique (p = 0.02), but there were no significant differences at any of the other postoperative time points. coNclusioNs This is the first multicenter study to examine the effect of the transsphenoidal surgical technique on sinonasal QOL and health status. The study showed that surgical technique did not significantly impact these patientreported measures when performed at high-volume centers.Clinical trial registration no.: NCT01504399 (clinicaltrials.gov).http://thejns.org/doi/abs

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confidence: 99%

Comparison of sinonasal quality of life and health status in patients undergoing microscopic and endoscopic transsphenoidal surgery for pituitary lesions: a prospective cohort study

Little

Kelly

Milligan

et al. 2015

JNS

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“…However, anatomical variations do occur frequently and it is in these situations that surgery might become more difficult and require surgical experience. Septum deviations (present in 63% of patients with sinonasal symptoms [16] and 54% in a series of patients operated by a sublabial transseptal approach [17]), spina septi, concha bullosa present in 22–53% on thin-sliced CT scanning and often associated with the deviation of the nasal septum to the contralateral side [18] and a narrow lumen of the nose all might hinder the unobscured vision and unhampered introduction of the endoscope and/or various instruments. Also, one can become anatomically disoriented, which can cause serious morbidity, e.g., CSF fistula, internal carotid artery injury, and optic nerve injury.…”

Section: Discussionmentioning

confidence: 99%

“…Whether an ENT surgeon or a neurosurgeon was performing the approach did not affect these results; although the ENT surgeon tends to correct a septum deviation to allow a binostril approach, while the neurosurgeon converts to a mononostril approach to deal with this problem. The advantage of a direct reconstruction of the septal alignment may be a subjective improvement in nasal function [17]. Therefore, in patients with nasal airway obstruction symptoms before surgery because of septal deviation, septal correction should be reconsidered.…”

Section: Discussionmentioning

confidence: 99%

Variations of endonasal anatomy: relevance for the endoscopic endonasal transsphenoidal approach

et al. 2010

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BackgroundThe endoscopic endonasal transsphenoidal approach (EETA) to the pituitary is performed by ear, nose, and throat (ENT) surgeons in collaboration with neurosurgeons but also by neurosurgeons alone even though neurosurgeons have not been trained in rhinological surgery.PurposeTo register the frequency of endonasal anatomical variations and to evaluate whether these variations hinder the progress of EETA and require extra rhinological surgical skills.MethodsA prospective cohort study of 185 consecutive patients receiving an EETA through a binostril approach was performed. All anatomical endonasal variations were noted and the relevance for the progress of surgery evaluated.ResultsIn 48% of patients, anatomical variations were recognized, the majority of which were spinae septi and septum deviations. In 5% of patients, the planned binostril approach had to be converted into a mononostril approach; whereas in 18% of patients with an anatomical variation, a correction had to be performed. There was no difference between the ENT surgeon and the neurosurgeon performing the approach. Complications related to the endonasal phase of the surgery occurred in 3.8%. Fluoroscopy or electromagnetic navigation has been used during 6.5% of the surgeries.ConclusionAlthough endonasal anatomical variations are frequent, they do not pose a relevant obstacle for EETA.

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“…We recently described the nasal septum after sublabial transseptal transsphenoidal pituitary surgery in 55 patients 3 . Although the approach is more extensive, we still utilized the same principles to release the septum.…”

Section: Discussionmentioning

confidence: 99%