Postoperative nasal symptoms associated with an endoscopic endonasal transsphenoidal approach
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RHINOLOGY
Postoperative nasal symptoms associated with an endoscopic endonasal transsphenoidal approach Boo-Young Kim • Hye Lim Son • Seok-Gu Kang • Sung Won Kim • Yong Kil Hong • Sin-Soo Jeun • Soo Whan Kim • Jin Hee Cho • Yong Jin Park
Received: 16 August 2012 / Accepted: 7 October 2012 / Published online: 19 October 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract Recent studies have indicated the usefulness of endoscopic endonasal transsphenoidal approach (EETSA). A few studies have reported on the postoperative nasal symptoms of patients who have undergone EETSA. Therefore, we adopted a rhinologic perspective to compare preoperative and postoperative nasal symptoms after performing a binostril, four-hand EETSA. Patients who were scheduled to undergo binostril, four-hand EETSA underwent preoperative nasal evaluation using the Nasal Obstruction Symptom Evaluation (NOSE), Sino-Nasal Outcome Test-20 (SNOT-20), and a visual analogue scale (VAS) to assess several nasal symptoms. Repeat testing was performed 6 months postoperatively. Paired Student’s t tests were used to compare preoperative and postoperative scores. A total of 142 patients who underwent a binostril, four-hand EETSA were included in this study. We found no statistically significant differences between preoperative and postoperative NOSE, total SNOT-20 scores, or scores on the VAS for nasal obstruction, sneezing, rhinorrhea, snoring, or facial pain. However, VAS of olfactory change increased significantly after EETSA (p \ 0.05). The binostril, four-hand EETSA would be a useful method because it permits operative manipulability and a wide visual field for skull base lesions. However, rhinologists
B.-Y. Kim H. L. Son S. W. Kim (&) S. W. Kim J. H. Cho Y. J. Park Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, 137-701 Seoul, Korea e-mail: [email protected] S.-G. Kang Y. K. Hong S.-S. Jeun Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
must consider postoperative nasal symptoms and perform a proper preoperative examination, especially with regard to the olfactory function, and inform patients scheduled for EETSA of potential postoperative changes. Keywords Nasal symptom Endoscope Transsphenoidal approach
Introduction Since Cushing pioneered the transsphenoidal route for pituitary surgery [1], this approach has been the standard surgical treatment for sellar tumors [2], and use of the endoscopic endonasal transsphenoidal approach (EETSA) for skull base lesions has increased. EETSA has resulted in unprecedented brightness and clarity of vision combined with the unique ability to explore the tumor bed with angled views and hydroscopy. Although outcomes and complication rates are comparable to those of traditional transsphenoidal approaches, EETSA involves less dissection and tissue manipulation, and greater patient comfort and acceptance [3]. Among the delayed postoper
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