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 and a half-year-collective regarding the rhinological outcome.

Methods: Since October 2015 a number of 82 patients (47 m, 35 f, median age 55y) matched the inclusion criteria and were treated via a transnasal endoscopic approach (binostril n=79, mononostril n=3). 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 is measured before, right after and six months after surgery with a standardized questionnaire (SNOT-20). The results were evaluated in cooperation with the department of medical statistics.

Results: 7,0% of the patients underwent previous transsphenoidal surgery, in addition 12,8% had previous septum-, pansinus or combined nasal surgery. Only 2,3% of the study participants had recurrence of adenoma which was primarily treated with a transcranial approach. Prior to surgery (n=82) the average odor was found to be 30,75 (≥31 = normosmia), in the post interventional examination (n=75) the average increased to 33,08 (p<0,001). Rhinomanometric examination of binostril nasal airflow showed an average of 596,90 ml/s on inspiration [range: 109,00–1446,00 ml/s] before, and an increase to 729,17 ml/s on inspiration [range: 266,00–1390,00 ml/s] within the inspection interval. SNOT-20 symptom scores showed an improvement right after and six months after surgery (score 59 and 51 vs. 68 before surgery). Due to our endoscopic observations (synechia, crusting, defects of nasal septum) we postulate a relationship to sensitively dealing with vital mucosa and restrictive use of bipolar coagulation.

Conclusion: Besides other relevant clinical markers the rhinological outcome, as it highly impacts on patients quality of life, should also be considered in clinical routine in transnasal skull base surgery.