Background: Endoscopic skull base surgery is now the preferred treatment option to remove skull base tumors.

Objective: To evaluate the patient’s sense of smell and mucociliary clearance time (MCT) after skull base surgery.

Methods: Patients with pituitary adenoma underwent a Transnasal Transphenoidal Endoscopic Approach (TTEA Group, N=36), while patients with other benign parasellar tumors underwent an Expanded Endonasal Approach (EEA Group, N=14) with a vascularized septal flap (VSF). Assessment of symptoms (Visual Analogue Scale, VAS), olfactometry (Barcelona Smell Test, BAST-24), and MCT (Saccharin test) were performed before and 3 months after surgery.

Results: Before surgery, patients reported poorer BAST-24 scores on detection, identification, and forced choice than the healthy population, while both study groups had similar sinonasal symptoms, BAST-24, and MCT scores. After surgery, no changes in symptom scores (VAS) were observed except for the loss of smell (26.7+/-30.5 mm, p<0.05) and posterior nasal discharge (29.7+/-30.3 mm, p<0.05) compared to baseline (5.2+/-11.3, 19.1+/-25.3, respectively). EEA patients reported higher loss of smell and posterior nasal discharge compared to TTEA. TTEA and EEA groups had similar scores on post-operative BAST-24. After surgery, however, patients showed prolonged Saccharin test (15.6+/-10.8 min, p<0.05) compared to baseline (8.4+/-4.4 min). In addition, EEA reported longer MCT than TTEA patients.

Conclusion: EEA but not TTEA has a short-term (3 months) negative impact on patient’s olfaction and mucociliary clearance. Patients should be informed about smell loss as a consequence of skull base surgery to prevent legal claims. Likewise, further research and some modifications on reconstruction flaps are encouraged to avoid damaging the olfactory neuroepithelium.

From: Impairment of Olfaction and Mucociliary Clearance After Expanded Endonasal Approach Using Vascularised Septal Flap Reconstruction for Skull Base Tumors by Alobid et al.

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