Comprehensive Management of the Paranasal Sinuses in Patients Undergoing Endoscopic Endonasal Skull Base Surgery

Nyquist, Gurston; Rosen, Marc; Friedel, Mark E.; Beahm, D. David; Farrell, Christopher; Evans, James J.

doi:10.1016/j.wneu.2014.07.027

Cited by 18 publications

(19 citation statements)

References 20 publications

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“…ESBS patients differ from chronic rhinosinusitis patients in that they presumably have lower rates of olfactory dysfunction and sinonasal morbidity prior to surgery . Thus, it is important to examine the ESBS cohort as a distinct group of patients.…”

Section: Introductionmentioning

confidence: 99%

“…10 ESBS patients differ from chronic rhinosinusitis patients in that they presumably have lower rates of olfactory dysfunction and sinonasal morbidity prior to surgery. 5,11 Thus, it is important to examine the ESBS cohort as a distinct group of patients. A few prior prospective and retrospective studies have examined subjective and objective olfactory outcomes in ESBS patients, all with conflicting results.…”

Section: Introductionmentioning

confidence: 99%

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Olfactory outcomes after endoscopic skull base surgery: A systematic review and meta‐analysis

et al. 2019

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Objectives Determine the effect of endoscopic skull base surgery (ESBS) on long‐term olfactory outcomes after surgery. Methods An English‐language search was conducted using the Cochrane, MEDLINE, Scopus, and Embase databases from January 2000 to October 2017 for adult patients undergoing ESBS with subjective and objective olfaction outcomes. Two authors independently examined articles to identify those meeting inclusion criteria. Studies examining objective olfactory outcomes after ESBS were included in the meta‐analysis. A random‐effects meta‐analysis of patients undergoing sellar and parasellar ESBS was conducted to compare preoperative and postoperative olfactory outcomes using the University of Pennsylvania Smell Identification Test (UPSIT) and Cross‐Cultural Smell Identification Test (CCSIT). Results Among 339 eligible articles, 29 articles met inclusion criteria. Twenty‐five of these focused on sellar and parasellar tumors. Individual articles not meeting criteria for meta‐analysis were qualitatively reported. Meta‐analysis showed there was no difference in preoperative and postoperative olfactory function after sellar and parasellar ESBS based on the UPSIT (five studies, mean difference [MD] = −1.03; 95% CI: −3.98, 1.93; P = .50) and the CCIST (three studies, MD = −0.77; 95% CI: −3.03, 1.49; P = .50). A pooled overall meta‐analysis revealed similar results (eight studies, effect size = −0.30; 95% CI: −0.79, 0.18; P = .22). However, heterogeneity for all meta‐analyses was high (I2 > 95%, P < .01), suggesting significant variation in the included studies. Conclusions Based on published objective olfaction outcomes after sellar and parasellar ESBS, there was no significant difference between preoperative and postoperative olfaction. Further prospective studies using validated objective measures of olfaction are required to improve our understanding on this subject. Level of Evidence 2a Laryngoscope, 129:1998–2007, 2019

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Olfactory outcomes after endoscopic skull base surgery: A systematic review and meta‐analysis

et al. 2019

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“…FESS was concurrently performed at the time of TSH in 15% of patients who developed post‐TSH rhinosinusitis, compared to 10% of patients without post‐TSH rhinosinusitis, which did not reach statistical significance. In cases of chronic rhinosinusitis or a history of recurrent acute rhinosinusitis in the absence of active infection, we believe it is safe to perform FESS concurrently with TSH . However, in the presence of acute bacterial infection or presence of fungal mycetoma, it is advised to medically treat the patient or perform staged FESS prior to TSH …”

Section: Discussionmentioning

confidence: 99%

“…In cases of chronic rhinosinusitis or a history of recurrent acute rhinosinusitis in the absence of active infection, we believe it is safe to perform FESS concurrently with TSH. 15 However, in the presence of acute bacterial infection or presence of fungal mycetoma, it is advised to medically treat the patient or perform staged FESS prior to TSH. 15 Significant differences in BMI were noted between patients who developed post-TSH rhinosinusitis after 3 months (mean BMI 34.3 kg/m 2 ) and those who did not develop post-TSH rhinosinusitis (mean BMI 30.4 kg/m 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…15 However, in the presence of acute bacterial infection or presence of fungal mycetoma, it is advised to medically treat the patient or perform staged FESS prior to TSH. 15 Significant differences in BMI were noted between patients who developed post-TSH rhinosinusitis after 3 months (mean BMI 34.3 kg/m 2 ) and those who did not develop post-TSH rhinosinusitis (mean BMI 30.4 kg/m 2 ). Both average BMIs are considered "obese" and multiple studies have demonstrated obesity to be a common comorbidity in patients with chronic rhinosinusitis.…”

Section: Discussionmentioning

confidence: 99%

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Rate of rhinosinusitis and sinus surgery following a minimally destructive approach to endoscopic transsphenoidal hypophysectomy

Rimmer

Vimawala

Chitguppi

et al. 2019

Int Forum Allergy Rhinol

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Background There remains considerable variation in the extent of sinonasal preservation during the approach for endoscopic transsphenoidal hypophysectomy (TSH). We advocate for a minimally destructive approach utilizing turbinate lateralization, small posterior septectomy, no ethmoidectomy, and preservation of nasoseptal flap (NSF) pedicles bilaterally. Due to these factors, this approach may affect the rates of postoperative rhinosinusitis. The objective of this study is to define the rates of postoperative rhinosinusitis in patients undergoing this approach. Methods Single institution, retrospective chart review of patients undergoing TSH from 2005 to 2018. Results A total of 415 patients were identified and 14% developed an episode of postoperative rhinosinusitis within 3 months. These patients were significantly more likely to have had a history of recurrent acute or chronic rhinosinusitis. Most cases were sphenoethmoidal sinusitis managed with 1 to 2 courses of antibiotics. Of patients with postoperative rhinosinusitis, most did not undergo NSF. Average follow‐up was 38 months. Six patients (1.4%) underwent post‐TSH functional endoscopic sinus surgery (FESS). Average time from TSH to FESS was 26.3 months. Two of these patients had a history of prior chronic rhinosinusitis without polyposis. Two patients underwent revision TSH for recurrent tumor as the primary indication for surgery at time of FESS. Twenty‐two–item Sino‐Nasal Outcome Test (SNOT‐22) scores generally increased immediately postoperatively, but frequently decreased below preoperative level by the time of last follow‐up, regardless of whether patients developed rhinosinusitis. Conclusion Sinonasal preservation during TSH is associated with a low rate of postoperative rhinosinusitis requiring FESS and excellent long‐term patient reported outcomes. We continue to advocate for sinonasal preservation during pituitary surgery.

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Perioperative management in endoscopic endonasal skull‐base surgery: a survey of the North American Skull Base Society

Roxbury

Lobo

Kshettry

et al. 2017

Int Forum Allergy Rhinol

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Background:The objective of this work was to be er understand variations in perioperative management in endoscopic endonasal skull-base surgery (EESBS) and to identify trends in management based upon the practice pa erns of North American Skull Base Society (NASBS) members. Methods:A 29-question survey evaluating perioperative EESBS management was sent to all NASBS members. Responses were analyzed with descriptive statistics. Subgroup analysis was performed based on participant demographics. A Bonferroni correction was performed and a p value <0.01 was considered statistically significant for subgroup analysis.Results: Of 651 invitees, 116 responded (17.8%). Participants were primarily from the United States (81.0%), and practiced in academic centers (83.6%). The majority were neurosurgeons (55.2%) or rhinologists (27.6%). Most surgeons (83.6%) advocated use of preoperative intravenous antibiotics (96.6%) and image guidance in all cases (83.6%). Lumbar drains were not recommended for cases in which an intraoperative cerebrospinal fluid (CSF) leak was not anticipated (94.8%). Nasoseptal flaps (NSFs) were not recommended in cases without intraoperative CSF leak (84.5%), but were recommended in cases of high-flow intraoperative CSF leak (97.4%). While postoperative restrictions were highly variable, most providers recommended CSF leak precautions (89.7%), flying restrictions (94.0%), and driving restrictions (95.6%) regardless of intraoperative CSF leak status. Most experts also recommended that continuous positive airway pressure (CPAP) be avoided for at least 2 weeks when an intraoperative CSF leak is encountered (81.9%). Conclusion:Despite variation in perioperative management of EESBS patients, important trends were identified by this study. Further investigation is needed to standardize perioperative practice pa erns in EESBS. C 2017 ARS-AAOA, LLC.

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Comprehensive Management of the Paranasal Sinuses in Patients Undergoing Endoscopic Endonasal Skull Base Surgery

Cited by 18 publications

References 20 publications

Olfactory outcomes after endoscopic skull base surgery: A systematic review and meta‐analysis

Olfactory outcomes after endoscopic skull base surgery: A systematic review and meta‐analysis

Rate of rhinosinusitis and sinus surgery following a minimally destructive approach to endoscopic transsphenoidal hypophysectomy

Perioperative management in endoscopic endonasal skull‐base surgery: a survey of the North American Skull Base Society

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