gms | German Medical Science

Objective: The sino-nasal outcome has often been neglected besides major criteria such as tumor resection, ophthalmological and endocrinological outcome in transnasal skull base surgery. In this prospective study we review a two-year-study group regarding the rhinological outcome.

Methods: Since October 2015 a total of 73 patients (39 m, 34 f) matched the inclusion criteria and were treated via a transnasal endoscopic approach. Primary endpoint is change in olfactory function, secondary nose breathing ability. Other than pituitary adenoma 4 Rathke cleft cysts, 2 colloid cysts, 1 mucocele, 1 craniopharyngeoma and 1 clivuschordoma were histologically found. The study participants are investigated by odor testing (Sniffin’ sticks), rhinomanometry and endoscopic inspection before and six months after surgery. Moreover quality of life was measured before, right after and six months after surgery with a standardized questionnaire (SNOT-20).

Results: 8,2% of the patients underwent previous transsphenoidal surgery, in addition 9,6% had previous septum-, pansinus or combined nasal surgery. Only 2,7% of the study participants had recurrence of adenoma which was primarily treated with a transcranial approach. Prior to surgery, the average ability to smell was found to be 30,37 (≥31 = normosmia): 32,9% of the patients showed hyposmia and even less, 8,2%, presented with functional anosmia. In the post interventional examination (n=49) functional anosmia (6,1%) and hyposmia (20,4%) were less common and the average increased to 33,32 (p<0,001). Rhinomanometric examination of binostril nasal airflow showed an average of 560,12 ml/s on inspiration [range: 109,00-1379,00 ml/s] before, and an increase to 705,61 ml/s on inspiration [range: 266,00-1312,00ml/s] within the inspection interval. Due to our observations we postulate a significant relationship to sensitively dealing with vital mucosa, restrictive use of bipolar coagulation and preservation of the sphenopalatine artery.

Conclusion: Besides other relevant clinical markers, the rhinological outcome should also be considered in clinical routine of transnasal skull base surgery as this has a high impact on the patients’ quality of life. Early evaluations of our study group showed no deterioration of the nasal function. Further prospective studies on the rhinological outcome via other approaches should be considered to be compared with these findings.