Impact of nasoseptal flap elevation on sinonasal quality of life in endoscopic endonasal approach to pituitary adenomas

Jalessi, Maryam; Jahanbakhshi, Amin; Amini, Elahe; Kamrava, Seyed Kamran; Farhadi, Mohammad

doi:10.1007/s00405-015-3729-z

Cited by 52 publications

(49 citation statements)

References 22 publications

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“…Correspondingly, Jalessi et al demonstrated that in patients with pituitary adenomas undergoing endoscopic endonasal transsphenoidal surgery, NSF harvest resulted in a transient decrease in QOL that returned to baseline within 3 months. Overall, there was significant improvement in SNOT‐22 scores at 12 months after surgery compared to preoperative data …”

Section: Discussionmentioning

confidence: 81%

“…Overall, there was significant improvement in SNOT-22 scores at 12 months after surgery compared to preoperative data. 33 Examining QOL in extended endonasal approaches with NSF reconstruction for benign skull base tumors, Georgalas et al demonstrated limited impact, which was mostly related to headache and reduced olfaction utilizing the Rhinosinusitis Outcome Measure-31 questionnaire. 34 Harvey et al found that sinonasal QOL was more closely related to skull base pathology compared to NSF use, suggesting that loss of sinonasal function from radiation or resection of functional areas including olfactory mucosa played a more important role.…”

Section: Discussionmentioning

confidence: 99%

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Long‐term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction

et al. 2018

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Objectives The utilization of the nasoseptal flap (NSF) in endoscopic anterior skull base surgery (EASB) has resulted in reduced rates of postoperative cerebrospinal fluid leak (CSF). The long‐term impact on sinonasal function after surgery remains incompletely defined. Methods A consecutive series of patients undergoing EASB with NSF and with at least 3 years follow‐up was prospectively evaluated. Patient demographics, pre‐ and postoperative Sino‐nasal Outcome Test‐22 (SNOT‐22) scores, Lund‐Mackay scores (LMS), CSF leak, and sinonasal complications were analyzed. Results A total of 46 patients undergoing EASB with NSF met inclusion criteria. The mean follow‐up was 67.4 months (range 39–90, standard deviation [SD] 14.2 months). No statistically significant differences were noted between the mean overall pre‐ (16) and postoperative SNOT‐22 scores (18). SNOT‐22 scores improved in 27 patients (58.7%), deteriorated in 17 patients (37.0%) and stayed the same in two patients (4.3%). Deterioration in SNOT‐22 scores was greater in younger (mean change + 7.2 [SD17.4] vs. older patients −3.4 [SD 7.5], P = 0.010). A statistically significant increase in LMS was noted (mean preoperative LMS0.9 vs. mean postoperative LMS 2.2, P = 0.001). The LMS decreased in nine patients (19.6%), increased in 22 patients (47.8%), and remained the same in 15 patients (32.6%). One patient (2.2%) developed a postoperative CSF leak following resection of metastatic skull base lesion and was successfully treated with placement of a lumbar drain, Foley catheter balloon, and strict bed rest. One patient (2.2%) developed a postoperative mucocele requiring decompression 3 years after initial surgery. Conclusion Whereas long‐term sinonasal quality of life is overall improved in the majority of patients following NSF use for EASB, younger patients show higher incidence of deterioration. Increased sinus opacification on imaging is generally noted and may require continued follow‐up and management. The incidence of reoperation for symptomatic mucocele formation is low. Level of Evidence 4 Laryngoscope, 129:1035–1040, 2019

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Long‐term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction

et al. 2018

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“…Next, we focused on studies of subjective olfaction after ESBS in the sella/parasella (Table ). Again, four of the seven studies found no long‐term (beyond 3 months) postoperative changes in subjective olfaction . Three studies found significantly worse postoperative olfaction using a subjective VAS .…”

Section: Discussionmentioning

confidence: 89%

“…Jalessi et al compared NSF reconstructions in ESBS to other types of fat or fascial grafts. They did find a transient deficit in postoperative olfaction at 1 month, but this was only in the NSF group, and it went on to return to baseline by 3 months . In contrast, Kim et al utilized bilateral rescue flaps for skull base reconstruction as opposed to NSF, and did find a significant worsening in subjective olfaction measured using a study‐specific VAS …”

Section: Resultsmentioning

confidence: 97%

“…Again, four of the seven studies found no long-term (beyond 3 months) postoperative changes in subjective olfaction. 15,[34][35][36] Three studies found significantly worse postoperative olfaction using a subjective VAS. [37][38][39] Of note, however, studies reporting outcomes using a VAS often showed inconsistencies in both the magnitude and directionality of the scale that is actually adopted and given to patients (i.e., 0-10 on the VAS, with 10 being worst smell vs. 0-100 on the VAS, with 100 being the best smell).…”

Section: Discussionmentioning

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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ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

157

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Impact of nasoseptal flap elevation on sinonasal quality of life in endoscopic endonasal approach to pituitary adenomas

Cited by 52 publications

References 22 publications

Long‐term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction

Long‐term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction

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

ICAR: endoscopic skull‐base surgery

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