Objective sinonasal functional outcomes in endoscopic anterior skull-base surgery: an evidence-based review with recommendations

Greig, Samuel R.; Cooper, Timothy; Sommer, Doron D.; Nair, Salil; Wright, Erin D.

doi:10.1002/alr.21760

Cited by 28 publications

(22 citation statements)

References 36 publications

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“…In a recent systematic review examining objective sinonasal outcomes including olfaction, mucociliary clearance, and nasal airflow, Greig et al identified 10 articles and concluded that NSF elevation led to impairment in olfactory function. The authors offer the option to avoid routine NSF elevation in sellar and parasellar procedures—and if a NSF is utilized, that the donor site defect reconstruction be considered . Lacking from these studies is a long‐term, prospective perspective of sinonasal QOL following NSF harvest in EASB surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The authors offer the option to avoid routine NSF elevation in sellar and parasellar procedures-and if a NSF is utilized, that the donor site defect reconstruction be considered. 36 Lacking from these studies is a long-term, prospective perspective of sinonasal QOL following NSF harvest in EASB surgery.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 Potential long-term complications include permanent hyposmia, sinonasal dysfunction, and delayed mucocele formation. [14][15][16] Although short-term outcome data has been examined, the longterm impact of EASB surgery with NSF on sinonasal quality of life (QOL) and radiographic outcomes remains incompletely defined. 17…”

Section: Introductionmentioning

confidence: 99%

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Long‐term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction

et al. 2018

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Objectives The utilization of the nasoseptal flap (NSF) in endoscopic anterior skull base surgery (EASB) has resulted in reduced rates of postoperative cerebrospinal fluid leak (CSF). The long‐term impact on sinonasal function after surgery remains incompletely defined. Methods A consecutive series of patients undergoing EASB with NSF and with at least 3 years follow‐up was prospectively evaluated. Patient demographics, pre‐ and postoperative Sino‐nasal Outcome Test‐22 (SNOT‐22) scores, Lund‐Mackay scores (LMS), CSF leak, and sinonasal complications were analyzed. Results A total of 46 patients undergoing EASB with NSF met inclusion criteria. The mean follow‐up was 67.4 months (range 39–90, standard deviation [SD] 14.2 months). No statistically significant differences were noted between the mean overall pre‐ (16) and postoperative SNOT‐22 scores (18). SNOT‐22 scores improved in 27 patients (58.7%), deteriorated in 17 patients (37.0%) and stayed the same in two patients (4.3%). Deterioration in SNOT‐22 scores was greater in younger (mean change + 7.2 [SD17.4] vs. older patients −3.4 [SD 7.5], P = 0.010). A statistically significant increase in LMS was noted (mean preoperative LMS0.9 vs. mean postoperative LMS 2.2, P = 0.001). The LMS decreased in nine patients (19.6%), increased in 22 patients (47.8%), and remained the same in 15 patients (32.6%). One patient (2.2%) developed a postoperative CSF leak following resection of metastatic skull base lesion and was successfully treated with placement of a lumbar drain, Foley catheter balloon, and strict bed rest. One patient (2.2%) developed a postoperative mucocele requiring decompression 3 years after initial surgery. Conclusion Whereas long‐term sinonasal quality of life is overall improved in the majority of patients following NSF use for EASB, younger patients show higher incidence of deterioration. Increased sinus opacification on imaging is generally noted and may require continued follow‐up and management. The incidence of reoperation for symptomatic mucocele formation is low. Level of Evidence 4 Laryngoscope, 129:1035–1040, 2019

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Long‐term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction

et al. 2018

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“…Similarly, Awad et al examined sinonasal morbidity after ESBS, but not specifically olfactory dysfunction . More recently, Thompson et al, Patel et al, and Greig et al all summarized key studies on olfactory outcomes after ESBS, but these were not comprehensive systematic reviews, and they did not perform a meta‐analysis …”

Section: Introductionmentioning

confidence: 99%

“…18 More recently, Thompson et al, Patel et al, and Greig et al all summarized key studies on olfactory outcomes after ESBS, but these were not comprehensive systematic reviews, and they did not perform a meta-analysis. 5,6,19 To date, no systemic review with meta-analysis has been performed to examine objective olfactory function after ESBS. Barriers to meta-analysis include potential differences in surgical technique, tumor histology, and olfactory testing.…”

Section: Introductionmentioning

confidence: 99%

Olfactory outcomes after endoscopic skull base surgery: A systematic review and meta‐analysis

et al. 2019

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Objectives Determine the effect of endoscopic skull base surgery (ESBS) on long‐term olfactory outcomes after surgery. Methods An English‐language search was conducted using the Cochrane, MEDLINE, Scopus, and Embase databases from January 2000 to October 2017 for adult patients undergoing ESBS with subjective and objective olfaction outcomes. Two authors independently examined articles to identify those meeting inclusion criteria. Studies examining objective olfactory outcomes after ESBS were included in the meta‐analysis. A random‐effects meta‐analysis of patients undergoing sellar and parasellar ESBS was conducted to compare preoperative and postoperative olfactory outcomes using the University of Pennsylvania Smell Identification Test (UPSIT) and Cross‐Cultural Smell Identification Test (CCSIT). Results Among 339 eligible articles, 29 articles met inclusion criteria. Twenty‐five of these focused on sellar and parasellar tumors. Individual articles not meeting criteria for meta‐analysis were qualitatively reported. Meta‐analysis showed there was no difference in preoperative and postoperative olfactory function after sellar and parasellar ESBS based on the UPSIT (five studies, mean difference [MD] = −1.03; 95% CI: −3.98, 1.93; P = .50) and the CCIST (three studies, MD = −0.77; 95% CI: −3.03, 1.49; P = .50). A pooled overall meta‐analysis revealed similar results (eight studies, effect size = −0.30; 95% CI: −0.79, 0.18; P = .22). However, heterogeneity for all meta‐analyses was high (I2 > 95%, P < .01), suggesting significant variation in the included studies. Conclusions Based on published objective olfaction outcomes after sellar and parasellar ESBS, there was no significant difference between preoperative and postoperative olfaction. Further prospective studies using validated objective measures of olfaction are required to improve our understanding on this subject. Level of Evidence 2a Laryngoscope, 129:1998–2007, 2019

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Long‐term olfaction outcomes in transnasal endoscopic skull‐base surgery: a prospective cohort study comparing electrocautery and cold knife upper septal limb incision techniques

Puccinelli

Yin

O’Brien

et al. 2019

Int Forum Allergy Rhinol

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Background: Olfactory nerve fibers are at risk of injury during transnasal endoscopic skull-base approaches. Olfactory outcomes for various techniques have not been thoroughly investigated. This study aims to report long-term olfactory outcomes when a cold knife upper septal limb incision technique is used compared to monopolar cautery. Methods:A prospective cohort study was performed at a tertiary referral center. Adult patients undergoing endoscopic approaches with septal incisions were randomized to cold knife or monopolar cautery groups. Patient demographics, clinical history, surgical data, and outcomes were collected. Preoperative, 3-month, and 12-month postoperative scores on the University of Pennsylvania Smell Inventory Test (UPSIT) and 22-item Sino-Nasal Outcome Test (SNOT-22) were measured. Fisher's exact tests were performed for categorical variables and t tests were performed for continuous variables.Results: Twenty-two (22) patients (10 cold knife, 12 cautery) were enrolled between March 2016 and August 2017. The average age ± standard deviation was 50.2 ± 14.0 years (p = 0.59), 54% (p = 0.69) were female, and the primary pathology was pituitary adenoma (73%, p = 1.00). Preoperative, 3-month, and 12-month postoperative UPSIT scores were similar between the cold knife and cautery groups (32.8 vs 32.4, p = 0.80; 33.1 vs 33.0, p = 0.96; 33.6 vs 33.3, p = 0.84). On the "sense of smell/taste" question of the SNOT-22, there was also no difference at all time points (p > 0.22). Conclusion:There was no significant change in patient UP-SIT scores 1 year a er transnasal skull-base approaches, and no short-term or long-term differences between cold knife and cautery upper septal limb incision techniques. Our study supports an individualized approach based on surgeon preference. C 2019 ARS-AAOA, LLC. Key Words: olfaction; endoscopic endonasal skull-base surgery; transsphenoidal; pituitary surgery; nasoseptal flap; rescue flap; quality of life How to Cite this Article: Puccinelli CL, Yin LX, O'Brien EK, et al. Long-term olfaction outcomes in transnasal endoscopic skull base surgery: a prospective cohort study comparing electrocautery and cold knife upper septal limb incision techniques. Int Forum Allergy Rhinol. 2019;9:493-500.

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Objective sinonasal functional outcomes in endoscopic anterior skull-base surgery: an evidence-based review with recommendations

Cited by 28 publications

References 36 publications

Long‐term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction

Long‐term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction

Olfactory outcomes after endoscopic skull base surgery: A systematic review and meta‐analysis

Long‐term olfaction outcomes in transnasal endoscopic skull‐base surgery: a prospective cohort study comparing electrocautery and cold knife upper septal limb incision techniques

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