Evaluation of sinonasal-related quality of life of 49 patients undergoing endoscopic skull base surgery

Abstract Objective This study aimed to evaluate the sinonasal-related Quality of Life (QoL) in patients undergoing endoscopic skull base surgery. Methods A retrospective study was performed, including patients with benign and malignant tumors at a single institution. Each patient completed the 22-Item Sino-Nasal Outcome Test (SNOT-22) and the Empty Nose Syndrome 6 Item Questionnaires (ENS6Q) to assess their perceived QoL at least 2-months after treatment. Results Forty-nine patients were enrolled in this study. The average score was 25.1 (Stander Deviation [SD] 14.99) for SNOT-22 and 6.51 (SD = 5.58) for ENS6Q. Analysis of the overall results for the SNOT-22 showed that olfactory damage was the most serious syndrome. The most frequently reported high-severity sub-domains in SNOT-22 were nasal symptoms and sleep symptoms. Nasal crusting was the most severe item in ENS6Q according to the report. Nine patients (18.4%) had a score higher than 10.5 which indicates the high risk of Empty Nose Syndrome (ENS). SNOT-22 score was related to the history of radiotherapy (p < 0.05), while the ENS6Q score was not. Conclusions The possibility of patients suffering from ENS after nasal endoscopic skull base surgery is at a low level, although the nasal cavity structure is damaged to varying degrees. Meanwhile, patients undergoing endoscopic skull base surgery were likely to suffer nasal problems and sleep disorders. Patients who had received radiotherapy have a worse QoL than those without a history of radiotherapy. Level of evidence Level 3.

Nasal Crust-Related Morbidity and Debridement After Endoscopic Skull Base Surgery

Abstract Introduction: Nasal crust after endoscopic skull base surgery can cause nasal congestion, obstruction, and pain, which can affect quality of life. The use of debridement aims to provide symptomatic relief and improve quality of life. Generally, most adult patients tolerate office-based debridement, except in a few select patients that require further sedation in the operating room for a debridement. The study sought to determine the rate of symptomatic crust-related morbidity and the rate of debridement in both the office and the operating room. Methods: Premorbid, operative, and postoperative data of adult patients who had endoscopic skull base surgery in our institution from 2014 to 2018 were reviewed retrospectively. The characteristics of nasal symptoms in the postoperative period were determined and the numberofdebridementsin theoffice and the operatingroomwere analyzed. Results: Two hundred and thirty-four (234) patients with 244 surgeries were included in the study. The majority, 68.9%, had a sellar lesion and a free mucosa graft (FMG) was the most common skull base reconstruction at 53.5%. One hundred and twenty (49.0%) had crust-related symptoms during the postoperative period and 11 patients (4.5%) required the operating room for debridement. The use of a pedicled flap, anxiety, and preoperative radiotherapy were significantly associated with intolerance to in-office debridement (p-value=0.05). Conclusions: The use of a pedicled flap or anxiety may predispose patients to require an OR debridement. Previous radiotherapy also influenced the tolerance to the in-office debridement.

Endoscopic endonasal approach for management of craniopharyngiomas (65 cases) / 中国内镜杂志

Objective To present our experience with management of craniopharyngiomas by endoscopic endonasal approach Methods A retrospective review of clinical data of 65 patients who were treated for craniopharyngiomas by endoscopic endonasal approach from February 2012 to May 2016. All patients were analyzed by treatment effect, complications, and follow-up result. Results Total removal of the tumors were completed in 52 cases (80.0%), subtotal removal in 11 cases (16.9%), and partial resection in 2 cases (3.1%). The pituitary stalks were identified in 57 cases when surgery, and severed in 41 cases (71.9%). Postoperative visual acuity was improved in 31 cases (47.7%), and 6 cases remained in the preoperative level, whereas worsening occurred in 1 case. Worsening of the anterior pituitary function was reported in 21 cases (32.3%). Transient diabetes insipidus after operation was occurred in 45 patients (69.2%), and long-term diabetes insipidus was occurred in 9 cases (13.8%). Postoperative cerebrospinal fluid (CSF) leak was occurred in 4 cases (6.2%), accompanied with intracranial infection, and all these cases were repaired under endoscope again, 3 cases were saved, but 1 case was dead. Perioperative mortality rate was 4.6%. 52 patients were followed up for 4.0 ~ 45.0 (mean, 20.8) months, and 44 patients (84.6%) returned life to normal. Obesity developed in 8 patients (15.4%), with 2 recurrent cases and no deaths during follow-up period. Conclusion The endoscopic endonasal approach is a safe and effective minimally invasive surgery approach for treating craniopharyngiomas, and has its own unique advantage.

Management of Carotid Artery Injury in Endonasal Surgery

Introduction: Carotid artery injury (CAI) is the most feared and potentially catastrophic intraoperative complication an endoscopic skull base surgeon may face. With the advancement of transnasal endoscopic surgery and the willingness to tackle more diverse pathology, evidence-based management of this life-threatening complication is paramount for patient safety and surgeon confidence. Objectives: We review the current English literature surrounding the management of CAI during endoscopic transnasal surgery. Data Synthesis The searched databases included PubMed, MEDLINE, Cochrane database, LILACS, and BIREME. Keywords included “sinus surgery,” “carotid injury,” “endoscopic skull base surgery,” “hemostasis,” “transsphenoidal” and “pseudoaneurysm.” Conclusions: Review of the literature found the incidence of CAI in endonasal skull base surgery to be as high as 9% in some surgeries. Furthermore, current treatment recommendations can result in damage to critical neurovascular structures. Management decisions must be made in the preoperative, operative, and postoperative setting to ensure adequate treatment of CAI and the prevention of its complications such as pseudoaneurysm. Emphasis should be placed on surgical competency, teamwork, and technical expertise through education and training...