Abstract
Background: The transpterygoid approach is often used alongside the transsphenoidal approach in endoscopic endonasal skull base surgery to access lateral skull base regions. This study investigates the sinonasal morbidity associated with this combined approach. Methods: We conducted a retrospective analysis of 70 adult patients who underwent either transsphenoidal (TS) or transsphenoidal plus transpterygoid (TS + TP) approaches at a tertiary academic hospital from 2018 to 2023. Sinonasal quality of life was measured using the Sinonasal Outcome Test (SNOT-22) at preoperative, 2-week, 6-week, and 12-week postoperative evaluations. Results: Both cohorts exhibited a significant increase in SNOT-22 scores at 2 weeks postoperatively (TS: mean increase of 8.5, p=0.020; TS + TP: mean increase of 12.3, p<0.001), which normalized by 6 and 12 weeks (TS: p=0.587 and p=0.987, respectively; TS + TP: p=0.378 and p=0.220, respectively). There were no statistically significant differences in sinonasal morbidity between the TS and TS + TP cohorts at any time point. Middle turbinate sacrifice was associated with higher SNOT-22 scores (B=12.559, p=0.035), indicating worsened sinonasal outcomes. Conclusions: The transpterygoid approach, when added to the transsphenoidal approach, does not increase long-term sinonasal morbidity. This suggests that the combined approach is a viable option for achieving broader surgical exposure without compromising sinonasal quality of life in the long term. Further studies with extended follow-up are needed to confirm these findings and explore additional quality of life metrics.
Published Version
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