Intranasal cross-sectional area and quality of life changes following endoscopic transsphenoidal skull base surgery

Abstract

Background: Endoscopic transsphenoidal surgical approaches to the skull base may produce alteration of intranasal architecture. Acoustic rhinometry (AR) can provide quantitative data on the nasal airway, which has not been previously applied to skull base surgery. We sought to employ AR to quantify the changes in nasal patency following endoscopic transsphenoidal surgery and identify the relationship between these changes and septal deviation, nasoseptal flap harvest, and sinonasal quality of life (QOL). Methods: Consecutive patients undergoing endoscopic transsphenoidal resection of a sellar or suprasellar tumor were prospectively enrolled. All subjects were adults who completed AR and the 22-item Sino-Nasal Outcome Test (SNOT-22) preoperatively and postoperatively. Cross-sectional area (CSA) was recorded at the internal nasal valve (CSA1), middle turbinate head (CSA2), and middle turbinate body (CSA3). Normative data were also collected from a larger cohort. Results: Forty patients met study criteria. Significant increases occurred postoperatively in mean CSA2 (1.08 cm2) and CSA3 (2.47 cm2) (p < 0.001), whereas CSA1 remained unchanged. Nasoseptal flap harvest and correction of septal deviation did not significantly alter mean postoperative AR values. Mean SNOT-22 scores were comparable despite septal pathology, whereas strong correlation was not found with change in AR values. Preoperative and postoperative QOL scores were not significantly affected by the presence of nasal septal deviation. Conclusion: The endoscopic transsphenoidal approach to the skull base can result in increased intranasal area without a detrimental effect on sinonasal QOL. These effects are independent of nasoseptal flap harvest and correction of nasal septal deviation.