Added Sinonasal Morbidity of Transpterygoid Approach versus Transsphenoidal Approach: A Case-Controlled Analysis

Abstract

Background

The transpterygoid approach is often used alongside the transsphenoidal approach in endoscopic endonasal skull base surgery to access lateral skull base regions. This study investigates the sinonasal morbidity associated with this combined approach.

Methods

We conducted a retrospective analysis of 70 adult patients who underwent either transsphenoidal (TS) or transsphenoidal plus transpterygoid (TS + TP) approaches at a tertiary academic hospital from 2018 to 2023. Sinonasal quality of life was measured using the Sinonasal Outcome Test (SNOT-22) at preoperative, 2-week, 6-week, and 12-week postoperative evaluations.

Results

Both cohorts exhibited a significant increase in SNOT-22 scores at 2 weeks postoperatively (TS: mean increase of 8.5, p = 0.020; TS + TP: mean increase of 12.3, p < 0.001), which normalized by 6 and 12 weeks (TS: p = 0.587 and p = 0.987, respectively; TS + TP: p = 0.378 and p = 0.220, respectively). There were no statistically significant differences in sinonasal morbidity between the TS and TS + TP cohorts at any time point. Middle turbinate (MT) sacrifice was associated with higher SNOT-22 scores (B = 12.559, p = 0.035), indicating worsened sinonasal outcomes.

Conclusion

The transpterygoid approach, when added to the transsphenoidal approach, does not increase long-term sinonasal morbidity. This suggests that the combined approach is a viable option for achieving broader surgical exposure without compromising sinonasal quality of life in the long term. Further studies with extended follow-up are needed to confirm these findings and explore additional quality of life metrics.

Keywords

transpterygoid approach - transsphenoidal approach - sinonasal morbidity - endoscopic endonasal skull base surgery - SNOT-22 - sinonasal quality of life - skull base surgery - middle turbinate sacrifice - sinonasal outcomes - retrospective analysis

Previous Presentation

Accepted for poster presentation at American Rhinologic Society 2024 COSM on May 17, 2024 in Chicago, Illinois.

Publication History

Received: 19 July 2024

Accepted: 05 January 2025

Accepted Manuscript online:
06 January 2025

Article published online:
24 January 2025

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