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J Neurol Surg B Skull Base 2024; 85(01): 021-027
DOI: 10.1055/a-1946-0240
Original Article

Sinonasal Outcomes of the Combined Transseptal/Transnasal Approach with Unilateral Nasoseptal Rescue Flap in Endoscopic Endonasal Transsphenoidal Surgery: A Propensity Score Matching Analysis

Jae-Sung Park
1   Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Do Hyun Kim
2   Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Sung Won Kim
2   Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Soo Whan Kim
2   Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Stephen Ahn
1   Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Mohammed Abdullah Basurrah
3   Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia
,
Sin-Soo Jeun
1   Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
› Author Affiliations Funding This work was supported by the National Research Foundation of Korea (NRF) (2022R1F1A1066232, 2019M3A9H2032424, 2019M3E5D5064110), and by the Ministry of Trade, Industry & Energy (MOTIE, Korea) (20012378). The sponsors had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Abstract

Objectives The authors applied surgical techniques acquired during the use of endoscopic combined transseptal/transnasal approach to reduce approach-related morbidity and improve sinonasal outcomes.

Study Design This is a retrospective cohort study of a prospectively collected database.

Setting The study setting involves a tertiary referral center.

Participants A total of 86 patients who underwent endoscopic endonasal transsphenoidal surgery for newly diagnosed pituitary adenomas from April 2018 to March 2021 were included. Patients treated via the combined transseptal/transnasal approach served as the study group (n = 18); those treated via the bilateral transnasal approach comprised the control group (n = 68). From the control group, propensity score matching (PSM) analysis was further performed to account for potential confounders and selection bias.

Main Outcome Measures Paired analysis was performed for pre- and 6-month-postoperative time points in study group, control group, and PSM control group. Olfactory function was evaluated by Connecticut Chemosensory Clinical Research Center (CCCRC) test, Cross-Cultural Smell Identification Test (CCSIT), and sinonasal outcomes were assessed by Sino-Nasal Outcome Test-22 (SNOT-22).

Results In the study group, CCCRC (p = 0.517) and CCSIT (p = 0.497) did not show any significant difference before and after surgery. There was some improvement in the symptom score of SNOT-22, but it was not statistically significant (p = 0.115). In the control group adjusted with PSM, a significant decrease in olfaction (p = 0.047) was observed using CCCRC. The CCSIT score was also decreased but not significant (p = 0.163). Also, there was no difference in the improvement of SNOT-22 (p = 0.781).

Conclusion Our new surgical method preserves olfactory function without compromising surgical outcomes.

Keywords

smell - nose - transnasal approach - sinonasal quality


Publication History

Received: 08 July 2022

Accepted: 13 September 2022

Accepted Manuscript online:
16 September 2022

Article published online:
01 November 2022

© 2022. Thieme. All rights reserved.

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