Endoscopic Modified Transseptal Transsphenoidal Approach for Maximal Preservation of Sinonasal Quality of Life and Olfaction.

Endoscopic Modified Transseptal Transsphenoidal Approach for Maximal Preservation of Sinonasal Quality of Life and Olfaction.

World Neurosurg. 2015 Dec 27;

Authors: Hong SD, Nam DH, Kong DS, Kim HY, Chung SK, Dhong HJ

Abstract
OBJECTIVE: Patients experience significant postoperative sinonasal symptoms for the first few months after endoscopic transnasal transsphenoidal approach (ETN-TSA) surgery. We modified this technique by bypassing the nasal mucosa and approaching through the septum bilaterally. In this study, we analyze whether these technical modifications, which we have termed the endoscopic modified transseptal transsphenoidal approach (EMTS-TSA), decrease postoperative sinonasal morbidity after endoscopic TSA.
METHODS: We retrospectively reviewed a prospectively collected database. Patients who underwent endoscopic TSA from Dec 2012 to Jun 2014 were included. Thirty patients underwent ETN-TSA and 51 underwent EMTS-TSA. Sino-Nasal Outcome Test (SNOT)-20, anterior skull base (ASK) nasal inventory, and visual analogue scale (VAS) for subjective olfaction were evaluated before and 1 and 3 months after surgery. Cross Cultural Smell Identification Test (CC-SIT) was also measured before and 3 months after surgery.
RESULTS: There was a significant difference between the preoperative and 3 month VAS for olfaction in the ETN-TSA group (92.5 to 81.3; P = 0.002) but not the EMTS-TSA group (from 90.6 to 88.8; P = 0.403). There was no statistical difference in SNOT-20 or CC-SIT scores between two groups during follow-up. The EMTS-TSA group scored better than the ETN-TSA group in the ASK nasal inventory subdomain ("nasal discharge", "urge to blow" and "trouble breading) 1 month postoperatively.
CONCLUSIONS: EMTS-TSA could preserve almost all nasal mucosa, including the septum and turbinates. EMTS-TSA may be useful for preserving early postoperative olfactory function and some sinonasal quality of life. We believe that EMTS-TSA is a good endoscopic pituitary surgery option.

PMID: 26732950 [PubMed - as supplied by publisher]

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