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J Neurol Surg B Skull Base 2014; 75(01): 065-072
DOI: 10.1055/s-0033-1356492
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Modifications to the Endoscopic Approach for Anterior Skull Base Lesions Improve Postoperative Sinonasal Symptoms

Christopher F. Thompson
1   Department of Head and Neck Surgery, University of California, Los Angeles, California, United States
,
Jeffrey D. Suh
1   Department of Head and Neck Surgery, University of California, Los Angeles, California, United States
,
Yuan Liu
1   Department of Head and Neck Surgery, University of California, Los Angeles, California, United States
,
Marvin Bergsneider
2   Department of Neurosurgery, University of California, Los Angeles, California, United States
,
Marilene B. Wang
1   Department of Head and Neck Surgery, University of California, Los Angeles, California, United States
› Author Affiliations
Further Information

Publication History

21 January 2013

29 July 2013

Publication Date:
10 October 2013 (online)

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Abstract

Background/Objective Our institution previously showed that patients experience significant postoperative sinonasal symptoms for the first few months after endoscopic transnasal transsphenoidal skull base surgery (eTNTS). Since our initial study we have modified our technique, discontinuing routine resection of the middle turbinate, maxillary antrostomies, and nasoseptal flaps. In this study, we analyze whether these technical modifications decrease postoperative sinonasal morbidity after eTNTS.

Methods A retrospective review was performed of 93 consecutive patients who underwent eTNTS at a tertiary academic medical center from August 2011 to August 2012.

Main Outcome Measures  Sino-Nasal Outcome Test (SNOT)-20 and SNOT-22 scores preoperatively and after surgery.

Results Compared with our previous study, our new cohort experienced a significant improvement (p < 0.05) in SNOT scores for the need to blow nose, runny nose, postnasal discharge, thick nasal discharge, wake up at night, reduced concentration, and frustrated/restless/irritable. Within the new cohort, patients who did not have a nasoseptal flap or middle turbinate resection had less worsening and faster improvement of nasal symptom scores after surgery.

Conclusions Preserving normal sinonasal physiology during eTNTS by limiting middle turbinate resections, avoiding unnecessary maxillary antrostomies, and reducing the use of nasoseptal flaps when feasible results in less sinonasal morbidity and more rapid recovery during the postoperative period.

Keywords

skull base - endonasal surgical approach - endoscopic surgery - nasoseptal flap

Note

We were awarded the “Best Clinical Paper by a Resident” at the 23rd Annual Meeting for the North American Skull Base Society; February 15–17, 2013; Miami, FL.


 

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