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. 2014 Feb;75(1):65-72.
doi: 10.1055/s-0033-1356492. Epub 2013 Oct 10.

Modifications to the endoscopic approach for anterior skull base lesions improve postoperative sinonasal symptoms

Christopher F Thompson  1 , Jeffrey D Suh  1 , Yuan Liu  1 , Marvin Bergsneider  2 , Marilene B Wang  1
Affiliations

Modifications to the endoscopic approach for anterior skull base lesions improve postoperative sinonasal symptoms

Christopher F Thompson et al. J Neurol Surg B Skull Base. 2014 Feb.

Abstract

Background/Objective Our institution previously showed that patients experience significant postoperative sinonasal symptoms for the first few months after endoscopic transnasal transsphenoidal skull base surgery (eTNTS). Since our initial study we have modified our technique, discontinuing routine resection of the middle turbinate, maxillary antrostomies, and nasoseptal flaps. In this study, we analyze whether these technical modifications decrease postoperative sinonasal morbidity after eTNTS. Methods A retrospective review was performed of 93 consecutive patients who underwent eTNTS at a tertiary academic medical center from August 2011 to August 2012. Main Outcome Measures Sino-Nasal Outcome Test (SNOT)-20 and SNOT-22 scores preoperatively and after surgery. Results Compared with our previous study, our new cohort experienced a significant improvement (p < 0.05) in SNOT scores for the need to blow nose, runny nose, postnasal discharge, thick nasal discharge, wake up at night, reduced concentration, and frustrated/restless/irritable. Within the new cohort, patients who did not have a nasoseptal flap or middle turbinate resection had less worsening and faster improvement of nasal symptom scores after surgery. Conclusions Preserving normal sinonasal physiology during eTNTS by limiting middle turbinate resections, avoiding unnecessary maxillary antrostomies, and reducing the use of nasoseptal flaps when feasible results in less sinonasal morbidity and more rapid recovery during the postoperative period.

Keywords: endonasal surgical approach; endoscopic surgery; nasoseptal flap; skull base.

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Conflict of interest statement

Conflict of interest The authors have nothing to disclose. No financial funding or support was received.

Figures

Fig. 1
Fig. 1
The mean change in factor score of psychological symptoms for patients who did and did not have (A) nasoseptal flap (NP), (B) middle turbinate resection, and (C) maxillary antrostomy. Abbreviation: mo, month.
Fig. 2
Fig. 2
The mean change in factor score of nasal symptoms for patients who did and did not have (A) nasoseptal flap (NP, (B) middle turbinate resection, and (C) maxillary antrostomy. Abbreviation: mo, month.
Fig. 3
Fig. 3
The mean change in factor score of ear and pressure symptoms for patients who did and did not have (A) nasoseptal flap (NP), (B) middle turbinate resection, and (C) maxillary antrostomy. Abbreviation: mo, month.
See this image and copyright information in PMC

References

    1. Liu J K, Das K, Weiss M H, Laws E R Jr, Couldwell W T. The history and evolution of transsphenoidal surgery. J Neurosurg. 2001;95(6):1083–1096. - PubMed
    1. Eloy J A, Vivero R J, Hoang K. et al. Comparison of transnasal endoscopic and open craniofacial resection for malignant tumors of the anterior skull base. Laryngoscope. 2009;119(5):834–840. - PubMed
    1. Tabaee A, Anand V K, Barrón Y. et al. Endoscopic pituitary surgery: a systematic review and meta-analysis. J Neurosurg. 2009;111(3):545–554. - PubMed
    1. Cappabianca P, Cavallo L M, Colao A. et al. Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invasive Neurosurg. 2002;45(4):193–200. - PubMed
    1. Balaker A E, Bergsneider M, Martin N A, Wang M B. Evolution of sinonasal symptoms following endoscopic anterior skull base surgery. Skull Base. 2010;20(4):245–251. - PMC - PubMed