Abstract
IntroductionEndoscopic endonasal transsphenoidal surgery (EETS) on the pituitary gland is considered safe and efficacious. The nasoseptal flap (NSF) is sometimes used to prevent or repair postoperative cerebrospinal fluid (CSF) leaks. Few investigators have quantified long-term quality-of-life (QOL) outcomes regarding sinonasal measures after EETS, with or without involvement of the NSF. This study assesses whether the septal flap affects sinonasal QOL outcomes for patients receiving EETS for pituitary adenoma.Methods and MaterialsThis is a retrospective study of patients who underwent EETS between 2013 and 2018. A total of 62 adults completed the Sinonasal Outcome Test-22 (SNOT-22) at least one year after the surgery. Outcome measures were compared between patients who underwent EETS with and without septal flap reconstruction.ResultsFor the entire cohort, there were 14 patients (22.6%) who had septal flap reconstruction and 48 patients (77.4%) who did not. Patient demographics, tumor characteristics, surgical outcomes, and duration between surgery and completion of the questionnaire were similar for both groups. The mean SNOT-22 scores in the no reconstruction (NR) group and the nasoseptal flap reconstruction (NSFR) group were similar (P=0.9). In terms of SNOT-22 subdomains (rhinologic symptoms, extranasal rhinologic symptoms, ear/facial symptoms, psychological dysfunction, and sleep dysfunction), no significant differences were found when comparing the groups.ConclusionAs compared with no reconstructive involvement, NSF utilization does not affect the QOL and nasal symptoms of patients undergoing EETS.
Highlights
Endoscopic endonasal transsphenoidal surgery (EETS) on the pituitary gland is considered safe and efficacious
Modern endoscopic pituitary surgery was introduced in France in 1992 and in the United States in 1997.2,3 In more recent years, this endoscopic technique has become widely accepted by otolaryngologists and neurosurgeons around the world, and its efficacy, safety, advantages, and disadvantages have been evaluated in numerous studies.[4,5,6,7,8,9,10]
In this study, we focus on comparing postoperative Sinonasal Outcome Test-22 (SNOT-22) QOL measures between patients who underwent EETS for pituitary adenoma with nasoseptal flap reconstruction (NSFR) and those who underwent the surgery with no reconstruction
Summary
Endoscopic endonasal transsphenoidal surgery (EETS) on the pituitary gland is considered safe and efficacious. The nasoseptal flap (NSF) is a neurovascularized mucoperichondrial and mucoperiosteal axial pattern flap, which is situated on the posterior branch of the sphenopalatine artery.[11] It is used commonly as part of the reconstructive phase of endoscopic pituitary surgery, primarily to prevent and/or seal cerebrospinal fluid (CSF) leaks, as well as to reconstruct the surgical defect to provide a healthy nasal microenvironment.[12] the impact of the nasoseptal flap reconstruction (NSFR) on nasal function due to manipulation of nasal mucosa has been a major concern, as nasal complications such as crusting, septal perforation, and cartilage necrosis have accompanied endoscopic endonasal approaches and NSF utilization.[13,14] These complications and their impacts on quality of life (QOL) have been the subject of investigations by several authors.[15,16,17,18,19,20]
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