Abstract:
The endoscopic endonasal approach is more disruptive to normal anatomy (particularly nasal mucosa) than the transseptal submucosal microscopic approach. This may result in greater postoperative nasal morbidity, in turn reducing quality of life. We aimed to assess the severity and time course of nasal morbidity, and its impact on quality of life, following endoscopic endonasal skull base surgery in this retrospective cohort study. We identified 95 patients who underwent endoscopic endonasal skull base surgery for anterior skull base pathologies. Nasal-specific questions from the Sino-Nasal Outcome Test-22 (SNOT-22) and the Anterior Skull Base inventory (ASB-12) were combined with quality-of-life questions. Patient demographics, diagnosis, and operative data were collected from electronic records. Age of the cohort ranged from 14-83 years. Time elapsed since surgery ranged from 3-85 months. 85/95 (89%) felt that nasal morbidity associated with surgery was acceptable, given the underlying reason for, and outcome of surgery; 10/95 (11%) did not. 71/95 (75%) reported no change or improvement in olfaction 3-months following surgery. 24/95 (25%) reported a deterioration in olfaction which was mild in 7%, moderate in 7%, and severe in 11%. Nasal crusting, nasal obstruction, and headache were moderately problematic symptoms but improved significantly by 3-month follow-up. Nasal discharge, nasal pain, and nasal whistling were mildly problematic and improved significantly by 3-months. 62/95 (65%) patients reported \'no change\' in day-to-day activities due to the effects on their nose after surgery. 19/95 (20%) had \'mild inconvenience\', 8/95 (8%) \'moderate inconvenience\' and 6/95 (6%) \'severe inconvenience\'. Endoscopic anterior skull base surgery is associated with nasal morbidity. Whilst 35% of patients appreciate a consequent negative impact on day-to-day life, the overwhelming majority feel that nasal morbidity is acceptable, given the wider surgical goals.
摘要:
与经中隔粘膜下显微镜入路相比,鼻内镜入路对正常解剖结构(尤其是鼻粘膜)的破坏更大。这可能导致更高的术后鼻部发病率,反过来降低生活质量。我们旨在评估鼻部发病的严重程度和时间进程,以及它对生活质量的影响,在这项回顾性队列研究中,鼻内镜颅底手术后。我们确定了95例接受内镜经鼻颅底手术治疗前颅底病变的患者。来自Sino-Nasal结果测试22(SNOT-22)和前颅骨基础清单(ASB-12)的鼻腔特定问题与生活质量问题相结合。患者人口统计学,诊断,手术数据是从电子记录中收集的。该队列的年龄范围为14-83岁。手术后经过的时间为3-85个月。85/95(89%)认为与手术相关的鼻腔发病率是可以接受的,考虑到根本原因,和手术结果;10/95(11%)没有。71/95(75%)报告术后3个月嗅觉无变化或改善。24/95(25%)报告嗅觉恶化,其中7%为轻度,7%中等,严重的11%。鼻腔结痂,鼻塞,头痛是中度问题症状,但经过3个月随访后明显改善.鼻腔分泌物,鼻痛,和鼻哨有轻微问题,并在3个月内明显改善。62/95(65%)的患者报告说,由于手术后对鼻子的影响,日常活动没有变化。19/95(20%)有“轻微不便”,8/95(8%)“中度不便”和6/95(6%)“严重不便”。内窥镜前颅底手术与鼻发病率有关。虽然35%的患者意识到随之而来的对日常生活的负面影响,绝大多数人认为鼻部发病率是可以接受的,考虑到更广泛的手术目标。