Patient-reported nasal morbidity following endoscopic endonasal skull base surgery

Gallagher, Mathew J.; Durnford, Andrew; Wahab, Salima; Nair, Salil; Rokade, Ashok; Mathad, Nijaguna

doi:10.3109/02688697.2014.887656

Cited by 37 publications

(51 citation statements)

References 13 publications

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“…None of these variables achieved statistical significant risk factors for nasal crusting [6,9]. However, de Almeida and colleagues, found that the only risk factor for nasal discharge was surgical complexity [6].…”

Section: Intraoperative Risk Factors For Sinonasal Morbiditymentioning

confidence: 91%

“…However, it should be noted that the two studies are from the same center and likely have overlapping patients. In contrast, Gallagher and colleagues observed different results of patient-reported nasal morbidity following EESBS [9]. One hundred and twenty four patients were interviewed with a median follow-up of 15 months.…”

Section: Time To Resolve Nasal Signs and Symptomsmentioning

confidence: 92%

“…Out of the 7 series we identified as reporting the spectrum of sinonasal morbidities after EESBS, only 3 reported the time for sinonasal signs and symptoms resolution as shown in Table 2. Two of these studies have reported most morbidities to take 3-4 months to resolve [6,11], while, a third study, which was retrospective, reported that 51% of patients with nasal crusting, 66% of patients with nasal discharge, and 51% of patients with decrease olfaction had their symptoms resolved in less than 4 weeks [9].…”

Section: Time To Resolve Nasal Signs and Symptomsmentioning

confidence: 96%

“…Our search identified 7 series [5][6][7][8][9][10][11] reporting the full spectrum of sinonasal complications and their incidences. Out of the 7 series, two studies were prospective while the remaining five were retrospective as summarized in Table 1.…”

Section: Assessing Types Of Postoperative Sinonasal Morbidities and Tmentioning

confidence: 99%

“…In the largest two studies reporting on sinonasal morbidity following EESBS [6,9], authors performed multivariable regression analysis, adjusting for the co-variants of age, sex, and surgery type. None of these variables achieved statistical significant risk factors for nasal crusting [6,9].…”

Section: Intraoperative Risk Factors For Sinonasal Morbiditymentioning

confidence: 99%

See 4 more Smart Citations

Sinonasal morbidity following endoscopic endonasal skull base surgery

Awad

Mohyeldin

El‐Sayed

et al. 2015

Clinical Neurology and Neurosurgery

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Section: Intraoperative Risk Factors For Sinonasal Morbiditymentioning

confidence: 91%

Section: Time To Resolve Nasal Signs and Symptomsmentioning

confidence: 92%

Section: Time To Resolve Nasal Signs and Symptomsmentioning

confidence: 96%

Section: Assessing Types Of Postoperative Sinonasal Morbidities and Tmentioning

confidence: 99%

Section: Intraoperative Risk Factors For Sinonasal Morbiditymentioning

confidence: 99%

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Sinonasal morbidity following endoscopic endonasal skull base surgery

Awad

Mohyeldin

El‐Sayed

et al. 2015

Clinical Neurology and Neurosurgery

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

Greig

Cooper

Sommer

et al. 2016

Int Forum Allergy Rhinol.

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Based on the available evidence, nasoseptal flap (NSF) elevation with or without use in reconstruction likely leads to impairment in objective olfactory function. Endoscopic sellar and parasellar surgery without the elevation of an NSF may lead to a transient reduction in olfactory function. In the absence of a high a priori risk of cerebrospinal fluid (CSF) leak, it is an option to avoid routine NSF elevation in sellar and parasellar procedures, with preservation of at least 1 vascular pedicle during the approach. Monopolar electrocautery for mucosal incisions may increase the risk of olfactory impairment. If an NSF is used, donor site defect reconstruction may be considered.

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Patient-reported nasal morbidity following endoscopic endonasal skull base surgery

Cited by 37 publications

References 13 publications

Sinonasal morbidity following endoscopic endonasal skull base surgery

Sinonasal morbidity following endoscopic endonasal skull base surgery

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

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

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