Prevalence and Clinical Significance of Radiographic Sinus Disease on Preoperative Computed Tomography Imaging in the Endoscopic Skull Base Surgery Population

Abstract

Introduction Endoscopic skull base surgery (ESBS) provides a safe, minimally invasive approach to treat benign and malignant skull base lesions. The significance of concomitant sinonasal pathology on imaging in patients undergoing ESBS and its effect on perioperative management is not well described. We sought to identify the prevalence and clinical significance of incidentally found radiographic sinus disease on preoperative imaging in patients undergoing ESBS and provide a protocol for management of these patients. Design A retrospective chart review was performed of consecutive patients who underwent ESBS from January 1, 2016 to June 30, 2018. Preoperative computed tomography (CT) scans were reviewed and scored using the Lund-Mackay (LM) staging system. Preoperative nasal endoscopy findings were analyzed. Any preoperative treatment based on these findings and changes in intraoperative management were examined. Results A total of 156 patients (81 women, 74 men) who underwent ESBS were reviewed. The average LM score was 2 ± 2.7 (range: 0–12). A total of 94 patients (60.3%) had evidence of radiographic sinus disease (LM score > 0) and 23 patients (14.7%) had presence of sphenoid sinus disease. Seven patients (4.5%) were treated preoperatively based on CT and/or nasal endoscopy findings. All patients who received preoperative treatment had evidence of sinus disease on imaging with an average score of 4.7 and were evaluated and treated within 1-2 weeks prior to ESBS. One patient had ESBS postponed until endoscopic sinus surgery was performed for extensive chronic rhinosinusitis (CRS) findings on imaging. Conclusion A review of preoperative imaging in patients undergoing ESBS can help identify concurrent sinonasal disease, which has the potential to alter preoperative as well as intraoperative management in these patients. We report a diligent but conservative approach for the treatment of concomitant CRS in the ESBS population with decision for preoperative treatment guided by various factors.

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“…Apesar disso, difere muito pouco nas taxas de ressecabilidade e complicações quando comparado ao método endoscópico na maioria das pesquisas 3,5,7,29 . O endoscópio é atualmente o método preferido pela maioria dos neurocirurgiões e otorrinolaringologistas, pois o mesmo apresenta um bom ângulo de visualização da lesão atrelado à possibilidade de se utilizar a técnica de 4 mãos "four hands" durante o procedimento, o que promove um maior potencial de exploração das regiões selar e parasselar 3,9,15,29 . O método endoscópico também é associado a uma melhor ressecção dos microadenomas hipofisários de linha média e oferece mais segurança e melhor visualização na exérese de macroadenomas hipofisários próximos à região do seio cavernoso 26 .…”

“…Normalmente são usadas ópticas de endoscopia rígidas com cerca de 180/4 mm com lentes de 0 º, 30 º ou 45º de angulação total. Vale ressaltar que o endoscópio é conectado a uma fonte luminosa para gerar uma melhor visualização da cavidade e em um aparelho de vídeo para visualização e documentação da cirurgia 3,9,15 .…”

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“…Chronic rhinosinusitis (CRS) is the most common preoperative issue, found in about half of EESBS candidates with preoperative sinonasal inflammation [ 11 ]. About 60% of EESBS patients have radiographic evidence of inflammatory sinus disease at presentation [ 12 ]. If detected preoperatively, rhinosinusitis is treated with intranasal topical steroids such as fluticasone or mometasone.…”

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“…However, the significance of the encountered pathology and the impact it has over preoperative and postoperative treatment has not been well described. In a retrospective study, Shah et al 7 sought to determine the prevalence of radiographic sinus disease and effect on management of in patients undergoing endoscopic skull base surgery, in addition to recommend a strategy for the management of these subset of patients based on their findings. They reviewed preoperative radiographic and clinical characteristics as well as any changes in preoperative or intraoperative management secondary to concerning findings.…”