Postoperative nasal symptoms associated with an endoscopic endonasal transsphenoidal approach

Abstract

Recent studies have indicated the usefulness of endoscopic endonasal transsphenoidal approach (EETSA). A few studies have reported on the postoperative nasal symptoms of patients who have undergone EETSA. Therefore, we adopted a rhinologic perspective to compare preoperative and postoperative nasal symptoms after performing a binostril, four-hand EETSA. Patients who were scheduled to undergo binostril, four-hand EETSA underwent preoperative nasal evaluation using the Nasal Obstruction Symptom Evaluation (NOSE), Sino-Nasal Outcome Test-20 (SNOT-20), and a visual analogue scale (VAS) to assess several nasal symptoms. Repeat testing was performed 6 months postoperatively. Paired Student's t tests were used to compare preoperative and postoperative scores. A total of 142 patients who underwent a binostril, four-hand EETSA were included in this study. We found no statistically significant differences between preoperative and postoperative NOSE, total SNOT-20 scores, or scores on the VAS for nasal obstruction, sneezing, rhinorrhea, snoring, or facial pain. However, VAS of olfactory change increased significantly after EETSA (p < 0.05). The binostril, four-hand EETSA would be a useful method because it permits operative manipulability and a wide visual field for skull base lesions. However, rhinologists must consider postoperative nasal symptoms and perform a proper preoperative examination, especially with regard to the olfactory function, and inform patients scheduled for EETSA of potential postoperative changes.

Olfactory changes after endoscopic endonasal transsphenoidal approach for skull base tumors

“…The superior incision for the conventional nasoseptal flap used in group A was designed from the inferior border of the sphenoidal sinus ostium following the sagittal plane of the septum, 1 cm below the most superior aspect of the septum, to avoid possible damage to the olfactory mucoepithelium . The curvilinear incision for the modified nasoseptal rescue flap used in group B was made from the inferior border of the sphenoidal sinus ostium following the sagittal plane of the septum made anteriorly toward the level one‐half to one‐third the height of the middle turbinate over the vomer . This curvilinear incision line is located farther from the olfactory neuroepithelium than the superior incision of the conventional nasoseptal flap.…”

Endoscopic endonasal transsphenoidal pituitary surgery: experience of 80 cases

“…glandular tissue and tumor (7,13,17). There are less endonasal complications (14), reduced hospital stays, better patient satisfaction, no postoperative nasal packing, and no risk of tooth numbness. There is also less risk for septal perforation without the submucosal bilateral dissection of the septum that is used in the traditional approach (14).…”

Sinonasal morbidity following endoscopic endonasal skull base surgery

“…Several questionnaires and tools have been introduced and used in clinical studies of endoscopic skull base surgery to assess QoL morbidity and sinonasal outcomes. These include Short Form-36 (SF-36), Anterior Skull Base Questionnaire (ASBQ), Rhinosinusitis Outcome Measure (RSOM)-31, Sinonasal Outcome Test (SNOT)-20, SNOT-22, and many others [6,7,24,26,[28][29][30][31][32][33]. However, due to several different questionnaires and no standardized definition for QoL, it is hard to compare different studies.…”