Charles A Riley1, Abtin Tabaee1, Lindsey Conley2, Muhamad Amine1, Christian P Soneru1, Vijay K Anand1, Theodore H Schwartz3. 1. Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York, U.S.A. 2. Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York, U.S.A. 3. Department of Neurosurgery, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York, U.S.A.
Abstract
OBJECTIVES: The utilization of the nasoseptal flap (NSF) in endoscopic anterior skull base surgery (EASB) has resulted in reduced rates of postoperative cerebrospinal fluid leak (CSF). The long-term impact on sinonasal function after surgery remains incompletely defined. METHODS: A consecutive series of patients undergoing EASB with NSF and with at least 3 years follow-up was prospectively evaluated. Patient demographics, pre- and postoperative Sino-nasal Outcome Test-22 (SNOT-22) scores, Lund-Mackay scores (LMS), CSF leak, and sinonasal complications were analyzed. RESULTS: A total of 46 patients undergoing EASB with NSF met inclusion criteria. The mean follow-up was 67.4 months (range 39-90, standard deviation [SD] 14.2 months). No statistically significant differences were noted between the mean overall pre- (16) and postoperative SNOT-22 scores (18). SNOT-22 scores improved in 27 patients (58.7%), deteriorated in 17 patients (37.0%) and stayed the same in two patients (4.3%). Deterioration in SNOT-22 scores was greater in younger (mean change + 7.2 [SD17.4] vs. older patients -3.4 [SD 7.5], P = 0.010). A statistically significant increase in LMS was noted (mean preoperative LMS0.9 vs. mean postoperative LMS 2.2, P = 0.001). The LMS decreased in nine patients (19.6%), increased in 22 patients (47.8%), and remained the same in 15 patients (32.6%). One patient (2.2%) developed a postoperative CSF leak following resection of metastatic skull base lesion and was successfully treated with placement of a lumbar drain, Foley catheter balloon, and strict bed rest. One patient (2.2%) developed a postoperative mucocele requiring decompression 3 years after initial surgery. CONCLUSION: Whereas long-term sinonasal quality of life is overall improved in the majority of patients following NSF use for EASB, younger patients show higher incidence of deterioration. Increased sinus opacification on imaging is generally noted and may require continued follow-up and management. The incidence of reoperation for symptomatic mucocele formation is low. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1035-1040, 2019.
OBJECTIVES: The utilization of the nasoseptal flap (NSF) in endoscopic anterior skull base surgery (EASB) has resulted in reduced rates of postoperative cerebrospinal fluid leak (CSF). The long-term impact on sinonasal function after surgery remains incompletely defined. METHODS: A consecutive series of patients undergoing EASB with NSF and with at least 3 years follow-up was prospectively evaluated. Patient demographics, pre- and postoperative Sino-nasal Outcome Test-22 (SNOT-22) scores, Lund-Mackay scores (LMS), CSF leak, and sinonasal complications were analyzed. RESULTS: A total of 46 patients undergoing EASB with NSF met inclusion criteria. The mean follow-up was 67.4 months (range 39-90, standard deviation [SD] 14.2 months). No statistically significant differences were noted between the mean overall pre- (16) and postoperative SNOT-22 scores (18). SNOT-22 scores improved in 27 patients (58.7%), deteriorated in 17 patients (37.0%) and stayed the same in two patients (4.3%). Deterioration in SNOT-22 scores was greater in younger (mean change + 7.2 [SD17.4] vs. older patients -3.4 [SD 7.5], P = 0.010). A statistically significant increase in LMS was noted (mean preoperative LMS0.9 vs. mean postoperative LMS 2.2, P = 0.001). The LMS decreased in nine patients (19.6%), increased in 22 patients (47.8%), and remained the same in 15 patients (32.6%). One patient (2.2%) developed a postoperative CSF leak following resection of metastatic skull base lesion and was successfully treated with placement of a lumbar drain, Foley catheter balloon, and strict bed rest. One patient (2.2%) developed a postoperative mucocele requiring decompression 3 years after initial surgery. CONCLUSION: Whereas long-term sinonasal quality of life is overall improved in the majority of patients following NSF use for EASB, younger patients show higher incidence of deterioration. Increased sinus opacification on imaging is generally noted and may require continued follow-up and management. The incidence of reoperation for symptomatic mucocele formation is low. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1035-1040, 2019.
Authors: Christina Dorismond; Griffin D Santarelli; Brian D Thorp; Adam J Kimple; Charles S Ebert; Adam M Zanation Journal: J Neurol Surg B Skull Base Date: 2020-08-07
Authors: Ricardo Landini Lutaif Dolci; Lígia Tédde de Moraes; Ana Carolina Mayor de Carvalho; Jeniffer Cristina Kozechen Rickli; Jamile Lopes de Souza; Williams Escalante Encinas; José Viana Lima Junior; Nilza Maria Scalissi; Américo Rubens Leite Dos Santos; Paulo Roberto Lazarini Journal: Eur Arch Otorhinolaryngol Date: 2020-09-28 Impact factor: 2.503