Using the Middle Turbinate to Protect the Skull Base in Endoscopic Transsphenoidal Surgery: A Cadaver Study

Shah, Janki; Tang, Dennis M.; Grafmiller, Kevin; Cappello, Zachary J.; Roxbury, Christopher R.; Sindwani, Raj

doi:10.1177/1945892420933173

Cited by 3 publications

(3 citation statements)

References 7 publications

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Section: Methodsmentioning

confidence: 99%

“…Advocates of MT preservation point to its role in olfaction, nasal moisturization and nasal airflow direction, as well as the theoretical increased risk of epistaxis postoperatively with MT resection. [42][43][44][45] In the initial description of routine MT preservation for sellar surgery, Nyquist et al describe MT preservation in 163 consecutive EEA cases, of which 99 were pituitary adenoma resections. In this series, they were able to preserve bilateral MTs in 160/163 cases.…”

Section: Turbinate Preservationmentioning

confidence: 99%

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Optimizing Quality of Life and Minimizing Morbidity through Nasal Preservation in Endoscopic Skull Base Surgery: A Contemporary Review

Pinheiro‐Neto

Rowan

Celda

et al. 2022

J Neurol Surg B Skull Base

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Introduction Endoscopic endonasal approaches (EEAs) are increasingly utilized for intracranial pathology. As opposed to sinonasal tumors, the nasal cavity is being used as a corridor to access these intracranial tumors but is not the site of primary surgical intent. Accordingly, there has been recent interest in preserving intranasal structures not directly involved by tumor and improving postoperative sinonasal quality of life (QOL). Objectives The aim of the study is to highlight recent advances in EEA techniques focused on improving sinonasal QOL including turbinate preservation, reducing the morbidity of reconstructive techniques, and the development of alternative minimally invasive EEA corridors. Methods The method of the study involves contemporary literature review and summary of implications for clinical practice. Results Nasoseptal flap (NSF) harvest is associated with significant morbidity including septal perforation, prolonged nasal crusting, and external nasal deformities. Various grafting and local rotational flaps have demonstrated the ability to significantly limit donor site morbidity. Free mucosal grafts have re-emerged as a reliable reconstructive option for sellar defects with an excellent sinonasal morbidity profile. Middle turbinate preservation is achievable in most EEA cases and has not been shown to cause postoperative obstructive sinusitis. Recently developed minimally invasive EEA techniques such as the superior ethmoidal approach have been described to better preserve intranasal structures while allowing intracranial access to resect skull base tumors and have shown promising sinonasal QOL results. Conclusion This contemporary review discusses balancing effective skull base reconstructive techniques with associated morbidity, the role of turbinate preservation in EEA, and the development of unique EEA techniques that allow for increased nasal structure preservation.

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Section: Methodsmentioning

confidence: 99%

Section: Turbinate Preservationmentioning

confidence: 99%

Optimizing Quality of Life and Minimizing Morbidity through Nasal Preservation in Endoscopic Skull Base Surgery: A Contemporary Review

Pinheiro‐Neto

Rowan

Celda

et al. 2022

J Neurol Surg B Skull Base

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“…Shah et al. 21 explored the role of middle turbinate preservation and medialization in preventing accidental skull based injury from nasogastric tube insertion after endoscopic transsphenoidal hypophysectomy using human cadavers. They report that the position of the middle turbinate can influence the risk of inadvertent postoperative intracranial nasogastric tube injury, and recommend middle turbinate preservation and deliberate medialization against the septum to reduce this risk.…”

mentioning

confidence: 99%