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J Neurol Surg B Skull Base 2024; 85(01): 021-027
DOI: 10.1055/a-1946-0240
Original Article

Sinonasal Outcomes of the Combined Transseptal/Transnasal Approach with Unilateral Nasoseptal Rescue Flap in Endoscopic Endonasal Transsphenoidal Surgery: A Propensity Score Matching Analysis

Jae-Sung Park
1   Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Do Hyun Kim
2   Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Sung Won Kim
2   Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Soo Whan Kim
2   Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Stephen Ahn
1   Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Mohammed Abdullah Basurrah
3   Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia
,
Sin-Soo Jeun
1   Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
› Author Affiliations Funding This work was supported by the National Research Foundation of Korea (NRF) (2022R1F1A1066232, 2019M3A9H2032424, 2019M3E5D5064110), and by the Ministry of Trade, Industry & Energy (MOTIE, Korea) (20012378). The sponsors had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Abstract

Objectives The authors applied surgical techniques acquired during the use of endoscopic combined transseptal/transnasal approach to reduce approach-related morbidity and improve sinonasal outcomes.

Study Design This is a retrospective cohort study of a prospectively collected database.

Setting The study setting involves a tertiary referral center.

Participants A total of 86 patients who underwent endoscopic endonasal transsphenoidal surgery for newly diagnosed pituitary adenomas from April 2018 to March 2021 were included. Patients treated via the combined transseptal/transnasal approach served as the study group (n = 18); those treated via the bilateral transnasal approach comprised the control group (n = 68). From the control group, propensity score matching (PSM) analysis was further performed to account for potential confounders and selection bias.

Main Outcome Measures Paired analysis was performed for pre- and 6-month-postoperative time points in study group, control group, and PSM control group. Olfactory function was evaluated by Connecticut Chemosensory Clinical Research Center (CCCRC) test, Cross-Cultural Smell Identification Test (CCSIT), and sinonasal outcomes were assessed by Sino-Nasal Outcome Test-22 (SNOT-22).

Results In the study group, CCCRC (p = 0.517) and CCSIT (p = 0.497) did not show any significant difference before and after surgery. There was some improvement in the symptom score of SNOT-22, but it was not statistically significant (p = 0.115). In the control group adjusted with PSM, a significant decrease in olfaction (p = 0.047) was observed using CCCRC. The CCSIT score was also decreased but not significant (p = 0.163). Also, there was no difference in the improvement of SNOT-22 (p = 0.781).

Conclusion Our new surgical method preserves olfactory function without compromising surgical outcomes.

Keywords

smell - nose - transnasal approach - sinonasal quality


Publication History

Received: 08 July 2022

Accepted: 13 September 2022

Accepted Manuscript online:
16 September 2022

Article published online:
01 November 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Li A, Liu W, Cao P, Zheng Y, Bu Z, Zhou T. Endoscopic versus microscopic transsphenoidal surgery in the treatment of pituitary adenoma: a systematic review and meta-analysis. World Neurosurg 2017; 101: 236-246
    CrossrefPubMedSearch in Google Scholar
  • 2 Roethlisberger M, Jayapalan RR, Hostettler IC. et al. Evolving strategies for resection of sellar/parasellar synchronous tumors via endoscopic endonasal approach: a technical case report and systematic review of the literature. World Neurosurg 2020; 133: 381-391.e2
    CrossrefPubMedSearch in Google Scholar
  • 3 Schwartz TH, Morgenstern PF, Anand VK. Lessons learned in the evolution of endoscopic skull base surgery. J Neurosurg 2019; 130 (02) 337-346
    CrossrefPubMedSearch in Google Scholar
  • 4 Castelnuovo P, Pistochini A, Locatelli D. Different surgical approaches to the sellar region: focusing on the “two nostrils four hands technique”. Rhinology 2006; 44 (01) 2-7
    PubMedSearch in Google Scholar
  • 5 Hadad G, Bassagasteguy L, Carrau RL. et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116 (10) 1882-1886
    CrossrefPubMedSearch in Google Scholar
  • 6 Kassam AB, Thomas A, Carrau RL. et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 2008;63(1, suppl 1):ONS44–ONS52, discussion ONS52–ONS53
    PubMed
  • 7 Rivera-Serrano CM, Snyderman CH, Gardner P. et al. Nasoseptal “rescue” flap: a novel modification of the nasoseptal flap technique for pituitary surgery. Laryngoscope 2011; 121 (05) 990-993
    CrossrefPubMedSearch in Google Scholar
  • 8 Stamm AC, Pignatari S, Vellutini E, Harvey RJ, Nogueira Jr JF. A novel approach allowing binostril work to the sphenoid sinus. Otolaryngol Head Neck Surg 2008; 138 (04) 531-532
    CrossrefPubMedSearch in Google Scholar
  • 9 Takemura M, Fujimoto Y, Kobayashi T. et al. A modified combined transseptal/transnasal binostril approach for pituitary lesions in patients with a narrow nasal space: technical note. Neurol Med Chir (Tokyo) 2014; 54 (08) 622-628
    CrossrefPubMedSearch in Google Scholar
  • 10 Hong SD, Nam DH, Kong DS, Kim HY, Chung SK, Dhong HJ. Endoscopic modified transseptal transsphenoidal approach for maximal preservation of sinonasal quality of life and olfaction. World Neurosurg 2016; 87: 162-169
    CrossrefPubMedSearch in Google Scholar
  • 11 Ozawa H, Tomita T, Watanabe Y. et al. Sigmoid incision rescue nasoseptal flap technique for endoscopic endonasal skull base surgery. Acta Otolaryngol 2016; 136 (06) 636-640
    CrossrefPubMedSearch in Google Scholar
  • 12 Snyderman C, Kassam A, Carrau R, Mintz A, Gardner P, Prevedello DM. Acquisition of surgical skills for endonasal skull base surgery: a training program. Laryngoscope 2007; 117 (04) 699-705
    CrossrefPubMedSearch in Google Scholar
  • 13 Kim BY, Shin JH, Kang SG. et al. Bilateral modified nasoseptal “rescue” flaps in the endoscopic endonasal transsphenoidal approach. Laryngoscope 2013; 123 (11) 2605-2609
    CrossrefPubMedSearch in Google Scholar
  • 14 Kim DH, Hong YK, Jeun SS. et al. Endoscopic endonasal transsphenoidal approach from the surgeon point of view. J Craniofac Surg 2017; 28 (04) 959-962
    CrossrefPubMedSearch in Google Scholar
  • 15 de Divitiis E, Laws ER, Giani U, Iuliano SL, de Divitiis O, Apuzzo ML. The current status of endoscopy in transsphenoidal surgery: an international survey. World Neurosurg 2015; 83 (04) 447-454
    CrossrefPubMedSearch in Google Scholar
  • 16 Rolston JD, Han SJ, Aghi MK. Nationwide shift from microscopic to endoscopic transsphenoidal pituitary surgery. Pituitary 2016; 19 (03) 248-250
    CrossrefPubMedSearch in Google Scholar
  • 17 Asemota AO, Ishii M, Brem H, Gallia GL. Comparison of complications, trends, and costs in endoscopic vs microscopic pituitary surgery: analysis from a US Health Claims Database. Neurosurgery 2017; 81 (03) 458-472
    CrossrefPubMedSearch in Google Scholar
  • 18 Bhenswala PN, Schlosser RJ, Nguyen SA, Munawar S, Rowan NR. Sinonasal quality-of-life outcomes after endoscopic endonasal skull base surgery. Int Forum Allergy Rhinol 2019; 9 (10) 1105-1118
    CrossrefPubMedSearch in Google Scholar
  • 19 Little AS, Kelly D, Milligan J. et al. Predictors of sinonasal quality of life and nasal morbidity after fully endoscopic transsphenoidal surgery. J Neurosurg 2015; 122 (06) 1458-1465
    CrossrefPubMedSearch in Google Scholar
  • 20 Mooney MA, Sarris CE, Zhou JJ. et al; TRANSSPHER Study Group. Proposal and validation of a simple grading scale (TRANSSPHER Grade) for predicting gross total resection of nonfunctioning pituitary macroadenomas after transsphenoidal surgery. Oper Neurosurg (Hagerstown) 2019; 17 (05) 460-469
    CrossrefPubMedSearch in Google Scholar
  • 21 Esposito F, Dusick JR, Fatemi N, Kelly DF. Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Oper Neurosurg (Hagerstown) 2007;60(4, Suppl 2)295–303, discussion 303–304
    PubMed
  • 22 Cain WS, Gent JF, Goodspeed RB, Leonard G. Evaluation of olfactory dysfunction in the Connecticut Chemosensory Clinical Research Center. Laryngoscope 1988; 98 (01) 83-88
    CrossrefPubMedSearch in Google Scholar
  • 23 Doty RL, Marcus A, Lee WW. Development of the 12-item Cross-Cultural Smell Identification Test (CC-SIT). Laryngoscope 1996; 106 (3 Pt 1): 353-356
    CrossrefPubMedSearch in Google Scholar
  • 24 de la Fuente A, Martín del Yerro JL. Management of the septum during rhinoplasty. Aesthetic Plast Surg 1995; 19 (05) 455-461
    CrossrefPubMedSearch in Google Scholar
  • 25 Park J-H, Choi JH, Kim Y-I, Kim SW, Hong Y-K. Modified graded repair of cerebrospinal fluid leaks in endoscopic endonasal transsphenoidal surgery. J Korean Neurosurg Soc 2015; 58 (01) 36-42
    CrossrefPubMedSearch in Google Scholar
  • 26 Ahn S, Park JS, Kim DH, Kim SW, Jeun SS. Surgical experience in prevention of postoperative CSF leaks using abdominal fat grafts in endoscopic endonasal transsphenoidal surgery for pituitary adenomas. J Neurol Surg B Skull Base 2021; 82 (05) 522-527
    Thieme ConnectPubMedSearch in Google Scholar
  • 27 Mishra A, Kawatra R, Gola M. Interventions for atrophic rhinitis. Cochrane Database Syst Rev 2012; (02) CD008280
    PubMedSearch in Google Scholar
  • 28 Frank-Ito DO, Sajisevi M, Solares CA, Jang DW. Modeling alterations in sinonasal physiology after skull base surgery. Am J Rhinol Allergy 2015; 29 (02) 145-150
    CrossrefPubMedSearch in Google Scholar
  • 29 Farzal Z, Del Signore AG, Zanation AM. et al. A computational fluid dynamics analysis of the effects of size and shape of anterior nasal septal perforations. Rhinology 2019; 57 (02) 153-159
    PubMedSearch in Google Scholar
  • 30 Lee IH, Kim DH, Park JS, Jeun SS, Hong YK, Kim SW. Cerebrospinal fluid leakage repair of various grades developing during endoscopic transnasal transsphenoidal surgery. PLoS One 2021; 16 (03) e0248229
    CrossrefPubMedSearch in Google Scholar