Olfactory functions after transsphenoidal pituitary surgery: Endoscopic versus microscopic approach

Kahiloğulları, Gökmen; Beton, Süha; Al‐Beyati, Eyyub S. M.; Kantarcioglu, Ozlem; Bozkurt, Melih; Kantarcioglu, Emrah; Cömert, Ayhan; Ünlü, Mustafa; Meço, Cem

doi:10.1002/lary.24037

Cited by 62 publications

(63 citation statements)

References 53 publications

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“…Additionally, the questionnaires at 2 and 4 weeks were completed by telephone, which may have led to a different response than the paper-based surveys. Nonetheless, our total sample size at all time points is similar to those in other studies that have measured QOL, 19 headache, 18 and sinonasal function 17,20,27 after transsphenoidal surgery. Additionally, the sample size is similar to those in other studies that have provided comparative analyses of QOL 19 and nasal function 17 between microscopic and endoscopic techniques.…”

Section: Study Advantages and Limitationsmentioning

confidence: 66%

“…In a study utilizing the sense of smell, Kahilogullari and colleagues found, through the use of the Smell Diskettes Olfaction Test, that the endoscope was more effective than the microscope in preserving olfactory function up to 6 months after surgery. 17 Although these added items would affect the total of the SNOT and NOSE construct scores, the addition of olfactory items would probably not affect the overall trend of our data given our specific analysis of the individual NOSE components and SNOT-20 subscales.…”

Section: Nasal and Nasal-related Qol Progressionmentioning

confidence: 94%

“…Patients were excluded if a combination of microscopic and endoscopic techniques was used in the surgical procedure. Eligible patients were asked to complete 4 preoperative questionnaires concerning their health: SinoNasal Outcome , 16 Nasal Obstruction Symptom Evaluation (NOSE), 17 SF-36, 18 and a headache scale. 11 Patients were then given follow-up surveys for the SNOT-20 and NOSE postoperatively on Day 1 or 2, 2 weeks, 4 weeks, 8 weeks, and 1 year.…”

Section: Methods Patient Recruitmentmentioning

confidence: 99%

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Prospective comparison of sinonasal outcomes after microscopic sublabial or endoscopic endonasal transsphenoidal surgery for nonfunctioning pituitary adenomas

Pledger¹,

Elzoghby

Oldfield³

et al. 2016

JNS

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obJective Both endoscopic and microscopic transsphenoidal approaches are accepted techniques for the resection of pituitary adenomas. Although studies have explored patient outcomes for each technique individually, none have prospectively compared sinonasal and quality of life outcomes in a concurrent series of patients at the same institution, as has been done in the present study. methods Patients with nonfunctioning adenomas undergoing transsphenoidal surgery were assessed for sinonasal function, quality of life, and pain using the Sino-Nasal Outcome , the short form of the Nasal Obstruction Symptom Evaluation (NOSE) instrument, the SF-36, and a headache scale. Eighty-two patients undergoing either endoscopic (47 patients) or microscopic (35 patients) surgery were surveyed preoperatively and at 24-48 hours, 2 weeks, 4 weeks, 8 weeks, and 1 year after surgery. results Patients who underwent endoscopic and microscopic transsphenoidal surgery experienced a similar recovery pattern, showing an initial increase in symptoms during the first 2 weeks, followed by a return to baseline by 4 weeks and improvement beyond baseline functioning by 8 weeks. Patients who underwent endoscopic surgery experienced better sinonasal outcomes at 24-48 hours (SNOT total p = 0.015, SNOT rhinologic subscale [ssRhino] p < 0.001), 2 weeks (NOSE p = 0.013), and 8 weeks (SNOT total p = 0.032 and SNOT ssRhino p = 0.035). By 1 year after surgery, no significant differences in sinonasal outcomes were observed between the 2 groups. Headache scales at 1 year improved in all dimensions except duration for both groups (total result 73%, p = 0.004; severity 46%, p < 0.001; frequency 53%, p < 0.001), with 80% of either microscopic or endoscopic patients experiencing improvement or resolution of headache symptoms. Endoscopic and microscopic patients experienced reduced vitality preoperatively compared with US population norms and remained low postoperatively. By 8 weeks after surgery, both groups experienced significant improvements in mental health (13%, p = 0.005) and vitality (15%, p = 0.037). By 1 year after surgery, patients improved significantly in mental health (14%, p = 0.03), role physical (14%, p = 0.036), social functioning (16%, p = 0.009), vitality (22%, p = 0.002), and SF-36 total (10%, p = 0.024) as compared with preoperative measures. There were no significant differences at any time point between the 2 groups for the total SF-36 or for any of the 8 subscales. coNclusioNs Patients who underwent either an endoscopic or a microscopic approach experienced the greatest nasal symptoms at 2 weeks postoperatively and exhibited similar time courses of recovery in nasal, headache, and quality of life assessments. Although patients who underwent endoscopic surgery experienced significantly fewer nasal symptoms during the first 8 weeks, by 1 year after surgery, there were no significant differences between the 2 groups.

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Section: Study Advantages and Limitationsmentioning

confidence: 66%

Section: Nasal and Nasal-related Qol Progressionmentioning

confidence: 94%

Section: Methods Patient Recruitmentmentioning

confidence: 99%

See 1 more Smart Citation

Prospective comparison of sinonasal outcomes after microscopic sublabial or endoscopic endonasal transsphenoidal surgery for nonfunctioning pituitary adenomas

Pledger¹,

Elzoghby

Oldfield³

et al. 2016

JNS

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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.…”

Section: Discussionmentioning

confidence: 99%

“…[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.…”

mentioning

confidence: 99%

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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Risk Factors for Patient-Reported Olfactory Dysfunction After Endoscopic Transsphenoidal Hypophysectomy

Lee

Thompson

Piccirillo

et al. 2020

JAMA Otolaryngol Head Neck Surg

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after endoscopic transsphenoidal hypophysectomy (ETSH) is an overlooked complication without elucidated risk factors.OBJECTIVE To assess the independent prognostic role of demographic, comorbidity, cephalometric, intraoperative, histological, and postoperative parameters in patient-reported postoperative olfactory dysfunction, and to explore the association between anatomical measurements of the skull base and sinonasal cavity and postoperative olfactory dysfunction. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study in a tertiary care medical center enrolled consecutive patients with primary sellar lesions who underwent ETSH between January 1, 2015, and January 31, 2019. Patients were excluded if they underwent multiple sinonasal surgical procedures, presented with a sellar malignant neoplasm, required an expanded transsphenoidal approach, had nasal polyposis or a neurodegenerative disease, or sustained traumatic brain injury. After undergoing medical record review and telephone screening, patients were asked to participate in a 3-item telephone survey. MAIN OUTCOMES AND MEASURESThe primary outcome was the Clinical Global Impressions change in smell rating, a validated transitional patient-reported outcome measure. Patients rated their change in smell before and after ETSH on a 7-point Likert scale, with the following response options: (1) much better, (2) somewhat better, (3) slightly better, (4) neither better nor worse, (5) slightly worse, (6) somewhat worse, or (7) much worse. Responses of slightly worse, somewhat worse, and much worse were surrogates for postoperative olfactory dysfunction status. Patient medical records, preoperative imaging scans, operative notes, and pathology reports were reviewed. RESULTS Of the 147 patients (mean [SD] age, 54 [15] years; 79 women [54%]) who responded to the telephone survey, 42 (29%) reported olfactory dysfunction after ETSH. Median (interquartile range [IQR]) time between the ETSH completion and survey response was 31.1 (21-43) months. On multivariable analysis, abdominal fat grafting (adjusted relative risk [aRR], 2.95; 95% CI, 1.89-4.60) was associated with postoperative olfactory dysfunction, whereas smoking history (aRR, 1.54; 95% CI, 0.95-2.51) demonstrated a clinically meaningful but imprecise effect size. A more obtuse angle between the planum sphenoidale and face of the sella turcica on sagittal imaging was protective (aRR, 0.98; 95% CI, 0.96-0.99). Increased number of months after the ETSH was associated with patient-reported normosmia (aRR, 0.93; 95% CI, 0.91-0.95). In contrast, other comorbidities; intraoperative variables such as turbinate resection, nasoseptal flap, and mucosal or bone grafting; histological variables such as pathology and proliferative index; and postoperative variables such as adjuvant radiotherapy were not associated with postoperative olfactory dysfunction.CONCLUSIONS AND RELEVANCE This study found that abdominal fat grafting, acute skull base angle, and smoking history appeared to be clinically significant risk factors...

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Olfactory functions after transsphenoidal pituitary surgery: Endoscopic versus microscopic approach

Cited by 62 publications

References 53 publications

Prospective comparison of sinonasal outcomes after microscopic sublabial or endoscopic endonasal transsphenoidal surgery for nonfunctioning pituitary adenomas

Prospective comparison of sinonasal outcomes after microscopic sublabial or endoscopic endonasal transsphenoidal surgery for nonfunctioning pituitary adenomas

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

Risk Factors for Patient-Reported Olfactory Dysfunction After Endoscopic Transsphenoidal Hypophysectomy

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