Preservation of Olfactory Function After Pediatric Endoscopic Endonasal Skull Base Surgery with Nasoseptal Flap Reconstruction

Abstract

Objective: Endoscopic endonasal surgery is a feasible approach to lesions of the pediatric skull base. Olfactory outcomes after endoscopic endonasal approach (EEA) have been reported in the adult literature, but pediatric outcome data are lacking. The purpose of this preliminary study is to evaluate postoperative olfactory outcomes in pediatric patients who underwent EEA through transsphenoidal and/or transclival corridors.

Methods: Retrospective chart review was undertaken of patients <18 years of age who underwent EEA with nasoseptal flap skull base reconstruction between March 2019 and January 2022. After their first postoperative debridement and 6 months after surgery, patients were administered the University of Pennsylvania Smell Identification Test to assess olfactory function.

Results: Fifteen patients (7 female, 8 male) with a mean age of 14.9 years met inclusion criteria. Thirteen (86.7%) patients required a transsphenoidal approach and 2 (13.3%) patients underwent a combined transsphenoidal and transclival approach. Mean time between surgical resection and first olfactory testing was 6.3 weeks (range 4.6-7.3 weeks). Nine patients (60.0%) had normosmia after EEA whereas 3 (20.0%) had mild microsmia, and 3 (20.0%) had moderate microsmia at 6 weeks after surgery. Results improved at their 6-month follow-up visits. No patients experienced postoperative severe microsmia or anosmia.

Conclusions: Olfactory preservation is possible after pediatric EEA, although 40% of patients will develop some degree of microsmia in the immediate postoperative period and 20% will have some persistent dysfunction at 6 months. Long-term data are necessary to determine whether microsmia continues to improve over time.

Keywords: Chordoma; Craniopharyngioma; Olfaction; Pediatric endonasal skull base surgery; Pituitary; Smell; Transsphenoidal.