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J Neurol Surg B Skull Base 2015; 76(06): 464-470
DOI: 10.1055/s-0035-1554905
Original Article
Georg Thieme Verlag KG Stuttgart · New York

The Olfactory Strip and Its Preservation in Endoscopic Pituitary Surgery Maintains Smell and Sinonasal Function

Richard J. Harvey
1   Department of Rhinology and Skull Base, University of New South Wales, Sydney, Australia
3   Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
,
Mark Winder
1   Department of Rhinology and Skull Base, University of New South Wales, Sydney, Australia
2   Department of Neurosurgery, St. Vincent's Hospital, Sydney, Australia
,
Andrew Davidson
3   Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
,
Tim Steel
2   Department of Neurosurgery, St. Vincent's Hospital, Sydney, Australia
,
Sunny Nalavenkata
1   Department of Rhinology and Skull Base, University of New South Wales, Sydney, Australia
,
Nadine Mrad
1   Department of Rhinology and Skull Base, University of New South Wales, Sydney, Australia
,
Ali Bokhari
1   Department of Rhinology and Skull Base, University of New South Wales, Sydney, Australia
,
Henry Barham
1   Department of Rhinology and Skull Base, University of New South Wales, Sydney, Australia
,
Anna Knisely
1   Department of Rhinology and Skull Base, University of New South Wales, Sydney, Australia
› Author Affiliations
Further Information

Publication History

10 January 2015

11 April 2015

Publication Date:
15 June 2015 (online)

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Abstract

Background The return of olfaction and of sinonasal function are important end points after pituitary surgery. Opinions differ on the impact of surgery because techniques vary greatly. A modified preservation of the so-called olfactory strip is described that utilizes a small nasoseptal flap and wide exposure.

Methods A cohort of patients undergoing pituitary surgery and endoscopic sinonasal tumor surgery were assessed. Patient-reported outcomes (Sino-Nasal Outcome Test [SNOT22] and Nasal Symptom Score [NSS]) were recorded. A global score of sinonasal function and the impact on smell and taste were obtained. Objective smell discrimination testing was performed in the pituitary group with the Smell Identification Test. Outcomes were assessed at baseline and at 6 months.

Results Ninety-eight patients, n = 40 pituitary (50.95 ± 15.31 years; 47.5% female) and n = 58 tumor (52.35 ± 18.51 years; 52.5% female) were assessed. For pituitary patients, NSSs were not significantly different pre- and postsurgery (2.75 ± 3.40 versus 3.05 ± 3.03; p = 0.53). SNOT22 scores improved postsurgery (1.02 ± 0.80 versus 0.83 ± 0.70; p = 0.046). Objective smell discrimination scores between baseline and 6 months were similar (31.63 ± 3.49 versus 31.35 ± 4.61; p = 0.68). No difference in change of olfaction was seen compared with controls (Kendall tau-b p = 0.46).

Conclusions Preservation of the olfactory strip can provide a low morbidity approach without adversely affecting olfaction and maintaining reconstruction options.

Keywords

smell - olfaction - nasoseptal - endoscopic - endonasal - pituitary
 

  • References

  • 1 Kim B-Y, Son HL, Kang S-G , et al. Postoperative nasal symptoms associated with an endoscopic endonasal transsphenoidal approach. Eur Arch Otorhinolaryngol 2013; 270 (4) 1355-1359
    CrossrefPubMedGoogle Scholar
  • 2 Wang YY, Srirathan V, Tirr E, Kearney T, Gnanalingham KK. Nasal symptoms following endoscopic transsphenoidal pituitary surgery: assessment using the General Nasal Patient Inventory. Neurosurg Focus 2011; 30 (4) E12
    PubMedGoogle Scholar
  • 3 Rotenberg BW, Saunders S, Duggal N. Olfactory outcomes after endoscopic transsphenoidal pituitary surgery. Laryngoscope 2011; 121 (8) 1611-1613
    CrossrefPubMedGoogle Scholar
  • 4 Hart CK, Theodosopoulos PV, Zimmer LA. Olfactory changes after endoscopic pituitary tumor resection. Otolaryngol He ad Neck Surg 2010; 142 (1) 95-97
    PubMedGoogle Scholar
  • 5 Lwu S, Edem I, Banton B , et al. Quality of life after transsphenoidal pituitary surgery: a qualitative study. Acta Neurochir (Wien) 2012; 154 (10) 1917-1922
    CrossrefPubMedGoogle Scholar
  • 6 Kahilogullari G, Beton S, Al-Beyati ESM , et al. Olfactory functions after transsphenoidal pituitary surgery: endoscopic versus microscopic approach. Laryngoscope 2013; 123 (9) 2112-2119
    CrossrefPubMedGoogle Scholar
  • 7 de Almeida JR, Carvalho F, Vaz Guimaraes Filho F , et al. A comparison of postoperative MRI signal changes between endoscopic endonasal approaches and open approaches for olfactory groove meningiomas: a match paired analysis from two institutions. J Neurol Surg B (Suppl BS1): 2014; S19
    PubMedGoogle Scholar
  • 8 Tam S, Duggal N, Rotenberg BW. Olfactory outcomes following endoscopic pituitary surgery with or without septal flap reconstruction: a randomized controlled trial. Int Forum Allergy Rhinol 2013; 3 (1) 62-65
    CrossrefPubMedGoogle Scholar
  • 9 Sowerby LJ, Gross M, Broad R, Wright ED. Olfactory and sinonasal outcomes in endoscopic transsphenoidal skull-base surgery. Int Forum Allergy Rhinol 2013; 3 (3) 217-220
    Google Scholar
  • 10 Simal Julián JA, Miranda Lloret P, Pancucci G, Sanromán Álvarez P, Botella Asunción C. Avoiding olfactory impairment after endoscopic endonasal expanded approaches. Neurosurgery 2013; 73 (3) E562-E563
    CrossrefPubMedGoogle Scholar
  • 11 Harvey RJ, Parmar P, Sacks R, Zanation AM. Endoscopic skull base reconstruction of large dural defects: a systematic review of published evidence. Laryngoscope 2012; 122 (2) 452-459
    CrossrefPubMedGoogle Scholar
  • 12 Harvey RJ, Malek J, Winder M , et al. Sinonasal morbidity following tumour resection with and without nasoseptal flap reconstruction. Rhinology 2014; . In press
    PubMedGoogle Scholar
  • 13 Hopkins C, Gillett S, Slack R, Lund VJ, Browne JP. Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol 2009; 34 (5) 447-454
    CrossrefPubMedGoogle Scholar
  • 14 Doty RL, Genow A, Hummel T. Scratch density differentiates microsmic from normosmic and anosmic subjects on the University of Pennsylvania Smell Identification Test. Percept Mot Skills 1998; 86 (1) 211-216
    CrossrefPubMedGoogle Scholar
  • 15 Doty RL, Shaman P, Dann M. Development of the University of Pennsylvania Smell Identification Test: a standardized microencapsulated test of olfactory function. Physiol Behav 1984; 32 (3) 489-502
    CrossrefPubMedGoogle Scholar
  • 16 Jo HW, Dalgorf DM, Snidvongs K, Sacks R, Harvey RJ. Postoperative irrigation therapy after sinonasal tumor surgery. Am J Rhinol Allergy 2014; 28 (2) 169-171
    CrossrefPubMedGoogle Scholar
  • 17 Alobid I, Enseñat J, Mariño-Sánchez F , et al. Expanded endonasal approach using vascularized septal flap reconstruction for skull base tumors has a negative impact on sinonasal symptoms and quality of life. Am J Rhinol Allergy 2013; 27 (5) 426-431
    CrossrefPubMedGoogle Scholar
  • 18 Alobid I, Enseñat J, Mariño-Sánchez F , et al. Impairment of olfaction and mucociliary clearance after expanded endonasal approach using vascularized septal flap reconstruction for skull base tumors. Neurosurgery 2013; 72 (4) 540-546
    CrossrefPubMedGoogle Scholar
  • 19 Kim S-W, Park KB, Khalmuratova R, Lee H-K, Jeon S-Y, Kim DW. Clinical and histologic studies of olfactory outcomes after nasoseptal flap harvesting. Laryngoscope 2013; 123 (7) 1602-1606
    CrossrefPubMedGoogle Scholar
  • 20 Say P, Leopold D, Cochran G, Smith L, Greiner T. Resection of the inferior superior turbinate: does it affect olfactory ability or contain olfactory neuronal tissue?. Am J Rhinol 2004; 18 (3) 157-160
    PubMedGoogle Scholar
  • 21 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 (5) 990-993
    CrossrefPubMedGoogle Scholar
  • 22 Phillips PS, Harvey RJ. Large skull base defect reconstruction with and without pedicled flaps. In: Palmer JN, Chiu A, , eds. Atlas of Endoscopic Sinus and Skull Base Surgery. Philadelphia, PA: Elsevier; 2012
    Google Scholar
  • 23 Kimple AJ, Leight WD, Wheless SA, Zanation AM. Reducing nasal morbidity after skull base reconstruction with the nasoseptal flap: free middle turbinate mucosal grafts. Laryngoscope 2012; 122 (9) 1920-1924
    CrossrefPubMedGoogle Scholar
  • 24 Zanation AM, Carrau RL, Snyderman CH , et al. Nasoseptal flap takedown and reuse in revision endoscopic skull base reconstruction. Laryngoscope 2011; 121 (1) 42-46
    CrossrefPubMedGoogle Scholar