Objectives: The literature suggests that after endoscopic endonasal transphenoidal surgery (EETS)
without formal reconstruction of the sella, sinonasal quality of life (QOL) recovers
by 3 to 6 months postoperatively. An option for sellar reconstruction, in the absence
of a significant intraoperative cerebrospinal fluid (CSF) leak, is a free mucosal
graft (FMG) taken from the posterior septum. In this study we analyze sinonasal quality
of life (QOL) outcomes in patients undergoing EETS with FMG reconstruction.
Design: Present study is a retrospective review.
Setting: This study was conducted at a tertiary care academic center.
Participants: Patients undergoing sellar reconstruction with a FMG after EETS from 2013 to 2018.
Main Outcome Measures: Patient, tumor, and surgical factors were included, along with postoperative complications.
Patients completed sinonasal outcome test 22 (SNOT-22) scores during the preoperative
visit, as well as first two postoperative visits. SNOT-22 scores were further categorized
into five domains, as previously described in the literature.
Results: A total of 115 patients underwent sellar reconstruction with a FMG during EETS. Most
surgeries were performed for pituitary adenomas (82%). Among the patients, 104 (90%)
had no intraoperative CSF leak, while 11 patients (10%) had a low-grade intraoperative
CSF leak. There was one patient (<1%) who developed a postoperative CSF leak. Three
patients (3%) developed epistaxis, requiring an emergency room visit or operative
intervention. The median time from surgery until the first postoperative visit was
13 days (95% CI: 6–22). The median time from surgery until the second postoperative
visit was 57 days (95% CI: 15–126). The average preoperative SNOT-22 score was 17.5;
first postoperative SNOT-22 score was 32.9; and second postoperative SNOT-22 score
was 21.3 ([Fig. 1]), suggesting near normalization of sinonasal QOL by the second postoperative visit.
After categorizing by SNOT-22 domains, there were significant improvements in SNOT-22
scores for almost all domains, including domain 1 (rhinologic symptoms), domain 2
(extra-nasal rhinologic symptoms), domain 3 (ear/facial Symptoms), and domain 4 (sleep
dysfunction) symptoms ([Fig. 2]).
Conclusion: During EETS, FMG reconstruction of sellar defects is an effective and well-tolerated
option for patients without significant intraoperative CSF leaks. Patients demonstrated
early recovery of baseline sinonasal QOL by 2 months postoperatively.
Fig. 1 Comparison of average preoperative and first two postoperative visit SNOT-22 scores.
Fig. 2 Comparison of individualized preoperative and first two postoperative visit SNOT-22
scores
