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KMID : 0390220220330040193
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Journal of Clinical Otolaryngology, Head and Neck Surgery
2022 Volume.33 No. 4 p.193 ~ p.202
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Sinonasal Complications after Endoscopic Transsphenoidal Approach: A Single Center Study
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Jang Hyo-Beom
Lee Jae-Min
Park Da-Hee
Roh Hwan-Jung
Lee Chi-Hyung
Sung Soon-Ki
Cho Kyu-Sup
Mun Sue-Jean
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Abstract
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Background and Objectives: The endoscopic transsphenoidal approach (TSA) is the standardized surgical approach to sella lesions providing a wider field and resulting in fewer neurosurgical complications. However, sinonasal complications are relatively less studied. This study aims to analyze sinonasal morbidities after endoscopic TSA performed by a single center.
Materials and Methods: Among 154 patients who underwent endoscopic TSA from 2015 to 2022, 107 patients who were followed up for more than 3 months were included and retrospectively reviewed. Sinonasal complications including crust, discharge, septal perforation, synechia and polypoid sphenoid mucosa at postoperative 3 month were evaluated with olfactory function. The patients were subdivided into nasoseptal flap (NSF), non-NSF, 1st phase (initial 3 years, n=53) and 2nd phase (later 4 years, n=54) groups for further analysis.
Results: There were 47 male (43.9%) with a mean age of 51.6 (range 15?83). The mean follow-up duration was 10.9 (range 3?46) months. Crust (28, 26.2%) was the most frequent morbidity followed by synechia (18, 16.8%), hyposmia (17, 15.9%), discharge (14, 13.1%), polypoid sphenoid mucosa and septal perforation (8, 7.5%). NSF was associated with crust formation and septal perforation (p<0.001). Olfactory function was relatively preserved at 3 month (p=0.065). Post- operative cerebrospinal fluid (CSF) leak decreased in the 2nd phase (4/54, 7.4%) compared to the 1st phase (12/53, 22.6%) (p<0.05).
Conclusion: Crust was the most frequent sinonasal morbidity after endoscopic TSA followed by synechia. NSF was associated with crust and septal perforation. Post-op CSF leaks could be reduced after overcoming the learning curve of endoscopic TSA.
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KEYWORD
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Endonasal transsphenoidal approach, Nasal cavity, Nasoseptal flap (NSF), Cerebrospinal fluid (CSF), Septal perforation
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