Changes in the Sphenoid Bone Encountered During the Endoscopic Endonasal Transsphenoidal Approach

Abstract

Objectives We estimated volume changes in the posterior bony wall of the sphenoid sinus, as well as alterations in nasal function (including olfactory function and subjective symptoms), after sphenoid mucosal repositioning using the endoscopic endonasal transsphenoidal approach (EETSA). Methods During 2010 and 2021, 13 patients underwent sphenoid mucosal repositioning during EETSA, while 24 patients (the control group) did not. Pre‐ and postoperative paranasal sinus computed tomography and the Mimics program were used to evaluate three‐dimensional changes in the posterior wall of the sphenoid sinus. All patients underwent the Connecticut Chemosensory Clinical Research Center (CCCRC) test, the Cross‐Cultural Smell Identification Test (CCSIT), Nasal Obstruction Symptoms Evaluation (NOSE), the Sino‐Nasal Outcome Test‐20 (SNOT‐20), and visual analog scale (VAS) evaluation. Results The increase in the volume of the posterior wall of the sphenoid sinus after surgery was objectively smaller in the sphenoid mucosal repositioning group than in the control group (P = .046). However, this did not affect olfactory function (as revealed by the CCCRC test or the CCSIT) or subjective symptoms (as revealed by the NOSE, SNOT‐20, and VAS scores) (all P > .05). Conclusion Surgical closure via sphenoid mucosal repositioning during EETSA reduces the volume of the posterior wall of the sphenoid sinus and facilitates re‐operation. We suggest that sphenoid mucosal repositioning is appropriate during EETSA. Level of Evidence 4 Laryngoscope, 132:965–972, 2022

Sphenoid Sinus Mucosal Flap after Transsphenoidal Surgery—A Systematic Review

“…Furthermore, isolation of more than one flap and closure in a multi-layered fashion is possible [23]. SMF could be successfully implemented either by absence or small CSF leak as a stand-alone or in a combined technique for larger ones [17,18,[21][22][23][24][25][26][27][28].…”

“…Application of SMF may also reduce the usage of fat grafts and the risk of associated necrosis [21,28]. SMF also promotes the normalization of the sphenoid sinus posterior wall [26]. Sellar reconstruction with SMF results in a better sinonasal QoL compared to NSF, as measured by the SNOT-22 Score for the first 6 weeks postoperatively (p < 0.05) [22].…”

“…Preserved SMFs maintain the physiological restoration of the posterior sphenoid sinus wall and facilitate exploration through a potential reoperation [26,27]. Preoperative planning is not only essential for a surgical approach but also for preparing the strategy for sellar reconstruction.…”

“…The sphenoid sinus is air-filled space within sphenoid bone and lined with mucosal membrane commonly known as sphenoid mucosa. Preservation and lateral shifting of the sphenoid mucosal flap during the transsphenoidal exposure of the sella may be important, as several studies reported the advantage of sphenoid mucosal flap (SMF) application for skull base reconstruction after transsphenoidal surgery [17,18,[21][22][23][24][25][26][27][28]. This is the first systematic review to evaluate the utility of SMF for skull base reconstruction after transsphenoidal surgery.…”