Sinonasal Outcomes of the Combined Transseptal/Transnasal Approach with Unilateral Nasoseptal Rescue Flap in Endoscopic Endonasal Transsphenoidal Surgery: A Propensity Score Matching Analysis

Jae-Sung Park; Do Hyun Kim; Sung Won Kim; Soo Whan Kim; Stephen Ahn; Mohammed Abdullah Basurrah; Sin-Soo Jeun

doi:10.1055/a-1946-0240

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2024; 85(01): 021-027
DOI: 10.1055/a-1946-0240

Original Article

Sinonasal Outcomes of the Combined Transseptal/Transnasal Approach with Unilateral Nasoseptal Rescue Flap in Endoscopic Endonasal Transsphenoidal Surgery: A Propensity Score Matching Analysis

Jae-Sung Park

¹Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

,

Do Hyun Kim

²Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

,

Sung Won Kim

²Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

,

Soo Whan Kim

²Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

,

Stephen Ahn

¹Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

,

Mohammed Abdullah Basurrah

³Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia

,

Sin-Soo Jeun

¹Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

› Author Affiliations

Abstract

Objectives The authors applied surgical techniques acquired during the use of endoscopic combined transseptal/transnasal approach to reduce approach-related morbidity and improve sinonasal outcomes.

Study Design This is a retrospective cohort study of a prospectively collected database.

Setting The study setting involves a tertiary referral center.

Participants A total of 86 patients who underwent endoscopic endonasal transsphenoidal surgery for newly diagnosed pituitary adenomas from April 2018 to March 2021 were included. Patients treated via the combined transseptal/transnasal approach served as the study group (n = 18); those treated via the bilateral transnasal approach comprised the control group (n = 68). From the control group, propensity score matching (PSM) analysis was further performed to account for potential confounders and selection bias.

Main Outcome Measures Paired analysis was performed for pre- and 6-month-postoperative time points in study group, control group, and PSM control group. Olfactory function was evaluated by Connecticut Chemosensory Clinical Research Center (CCCRC) test, Cross-Cultural Smell Identification Test (CCSIT), and sinonasal outcomes were assessed by Sino-Nasal Outcome Test-22 (SNOT-22).

Results In the study group, CCCRC (p = 0.517) and CCSIT (p = 0.497) did not show any significant difference before and after surgery. There was some improvement in the symptom score of SNOT-22, but it was not statistically significant (p = 0.115). In the control group adjusted with PSM, a significant decrease in olfaction (p = 0.047) was observed using CCCRC. The CCSIT score was also decreased but not significant (p = 0.163). Also, there was no difference in the improvement of SNOT-22 (p = 0.781).

Conclusion Our new surgical method preserves olfactory function without compromising surgical outcomes.

Keywords

smell - nose - transnasal approach - sinonasal quality

Full Text

References

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