내시경적 경접형동 접근법 후 발생하는 비부비동 합병증: 단일기관 연구
Sinonasal Complications after Endoscopic Transsphenoidal Approach: A Single Center Study
3
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background and Objectives: The endoscopic transsphenoidal approach (TSA) is the standardized surgical approach to sella lesions providing a wider field and resulting in fewer neurosurgical complications. However, sinonasal complications are relatively less studied. This study aims to analyze sinonasal morbidities after endoscopic TSA performed by a single center. Materials and Methods: Among 154 patients who underwent endoscopic TSA from 2015 to 2022, 107 patients who were followed up for more than 3 months were included and retrospectively reviewed. Sinonasal complications including crust, discharge, septal perforation, synechia and polypoid sphenoid mucosa at postoperative 3 month were evaluated with olfactory function. The patients were subdivided into nasoseptal flap (NSF), non-NSF, 1st phase (initial 3 years, n=53) and 2nd phase (later 4 years, n=54) groups for further analysis. Results: There were 47 male (43.9%) with a mean age of 51.6 (range 15–83). The mean follow-up duration was 10.9 (range 3–46) months. Crust (28, 26.2%) was the most frequent morbidity followed by synechia (18, 16.8%), hyposmia (17, 15.9%), discharge (14, 13.1%), polypoid sphenoid mucosa and septal perforation (8, 7.5%). NSF was associated with crust formation and septal perforation (p<0.001). Olfactory function was relatively preserved at 3 month (p=0.065). Post- operative cerebrospinal fluid (CSF) leak decreased in the 2nd phase (4/54, 7.4%) compared to the 1st phase (12/53, 22.6%) (p<0.05). Conclusion: Crust was the most frequent sinonasal morbidity after endoscopic TSA followed by synechia. NSF was associated with crust and septal perforation. Post-op CSF leaks could be reduced after overcoming the learning curve of endoscopic TSA.
Abstract
Background and Objectives: The endoscopic transsphenoidal approach (TSA) is the standardized surgical approach to sella lesions providing a wider field and resulting in fewer neurosurgical complications. However, sinonasal complications are relatively less studied. This study aims to analyze sinonasal morbidities after endoscopic TSA performed by a single center. Materials and Methods: Among 154 patients who underwent endoscopic TSA from 2015 to 2022, 107 patients who were followed up for more than 3 months were included and retrospectively reviewed. Sinonasal complications including crust, discharge, septal perforation, synechia and polypoid sphenoid mucosa at postoperative 3 month were evaluated with olfactory function. The patients were subdivided into nasoseptal flap (NSF), non-NSF, 1st phase (initial 3 years, n=53) and 2nd phase (later 4 years, n=54) groups for further analysis. Results: There were 47 male (43.9%) with a mean age of 51.6 (range 15–83). The mean follow-up duration was 10.9 (range 3–46) months. Crust (28, 26.2%) was the most frequent morbidity followed by synechia (18, 16.8%), hyposmia (17, 15.9%), discharge (14, 13.1%), polypoid sphenoid mucosa and septal perforation (8, 7.5%). NSF was associated with crust formation and septal perforation (p<0.001). Olfactory function was relatively preserved at 3 month (p=0.065). Post- operative cerebrospinal fluid (CSF) leak decreased in the 2nd phase (4/54, 7.4%) compared to the 1st phase (12/53, 22.6%) (p<0.05). Conclusion: Crust was the most frequent sinonasal morbidity after endoscopic TSA followed by synechia. NSF was associated with crust and septal perforation. Post-op CSF leaks could be reduced after overcoming the learning curve of endoscopic TSA.
참고문헌 (20)
- Liu JK, "The history and evolution of transsphenoidal surgery", J Neurosurg, 95(6), pp.1083~1096 (2001)
- Papay FA, "Transnasal transseptal endoscopic repair of sphenoidal cerebral spinal fluid fistula", Otolaryngol Head Neck Surg, 101(5), pp.595~597 (1989)
- Jho HD, "Endoscopic pituitary surgery", Pituitary, 2(2), pp.139~154 (1999)
- Higgins TS, "Analysis of transnasal endoscopic versus transseptal microscopic approach for excision of pituitary tumors", Am J Rhinol, 22(6), pp.649~652 (2008)
- de Almeida JR, "Nasal morbidity following endoscopic skull base surgery : a prospective cohort study", Head Neck, 33(4), pp.547~551 (2011)
- Kiraz M, "Comparison of sinonasal complications of microscopic and endoscopic approaches for transsphenoidal hypophyseal surgery : prospective study", Turk Neurosurg, 28(6), pp.915~922 (2018)
- Schreiber A, "Nasal morbidity and quality of life after endoscopic transsphenoidal surgery : a single-center prospective study", World Neurosurg, 123, pp.e557~e565 (2019)
- Birte-Antina W, "Olfactory training with older people", Int J Geriatr Psychiatry, 33(1), pp.212~220 (2018)
- Proctor DF, "The nose: upper airway physiology and the atmospheric environment" (1982), Elsevier Biomedical Press
- Naclerio RM, "Observations on the ability of the nose to warm and humidify inspired air", Rhinology, 45(2), pp.102~111 (2007)
- Bachert C, "Proinflammatory cytokines in allergic rhinitis", Eur Arch Otorhinolaryngol, 252(Suppl 1), pp.S44~S49 (1995)
- Stankiewicz JA, "Complications in endoscopic sinus surgery for chronic rhinosinusitis : a 25-year experience", Laryngoscope, 121(12), pp.2684~2701 (2011)
- Majovsky M, "Olfactory function in patients after transsphenoidal surgery for pituitary adenomas-a short review", Neurosurg Rev, 42(2), pp.395~401 (2019)
- Yanagisawa E, "Intranasal crusting following endoscopic surgery", Ear Nose Throat J, 74(6), pp.392~394 (1995)
- Kridel RWH, "Considerations in the etiology, treatment, and repair of septal perforations", Facial Plast Surg Clin North Am, 12(4), pp.435~450 (2004)
- Khalafallah AM, "Trends in endoscopic and microscopic transsphenoidal surgery : a survey of the international society of pituitary surgeons between 2010 and 2020", Pituitary, 23(5), pp.526~533 (2020)
- Zeng L, "Long-term olfactory dysfunction after single-nostril endoscopic transnasal transsphenoidal pituitary adenoma surgery", J Clin Neurosci, 82(Pt A), pp.166~172 (2020)
- Kuwata F, "Long-term olfactory function outcomes after pituitary surgery by endoscopic endonasal transsphenoidal approach", Auris Nasus Larynx, 47(2), pp.227~232 (2020)
- Seo MY, "Extended approach or usage of nasoseptal flap is a risk factor for olfactory dysfunction after endoscopic anterior skullbase surgery : results from 928patients in a single tertiary center", Rhinology, 58(6), pp.574~580 (2020)
- Lavigne P, "Complications of nasoseptal flap reconstruction : a systematic review", J Neurol Surg B Skull Base, 79(Suppl 4), pp.S291~S299 (2018)