title: Impairment of olfaction and mucociliary clearance after expanded endonasal approach using vascularized septal flap reconstruction for skull base tumors.
abstract: 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 transsphenoidal endoscopic approach (TTEA group, n = 36), whereas patients with other benign parasellar tumors underwent an expanded endonasal approach (EEA group, n = 14) with a vascularized septal flap. Assessment of symptoms (Visual Analogue Scale), 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, but both study groups had similar sinonasal symptoms, BAST-24, and MCT scores. After surgery, no changes in symptom scores (Visual Analogue Scale) were observed except for the loss of smell (26.7 ± 30.5 mm, P < .05) and posterior nasal discharge (29.7 ± 30.3 mm, P < .05) compared with baseline (5.2 ± 11.3, 19.1 ± 25.3, respectively). EEA patients reported higher loss of smell and posterior nasal discharge compared with TTEA. TTEA and EEA groups had similar scores on postoperative BAST-24. After surgery, however, patients showed prolonged saccharin test (15.6 ± 10.8 min, P < .05) compared with baseline (8.4 ± 4.4 min). In addition, EEA patients reported longer MCT than TTEA patients.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain. isamobid@hotmail.com
authors.forename: Isam
authors.initials: I
authors.lastname: Alobid
authors.forename: Joaquim
authors.initials: J
authors.lastname: Enseñat
authors.forename: Franklin
authors.initials: F
authors.lastname: Mariño-Sánchez
authors.forename: Matteo
authors.initials: M
authors.lastname: de Notaris
authors.forename: Silvia
authors.initials: S
authors.lastname: Centellas
authors.forename: Joaquim
authors.initials: J
authors.lastname: Mullol
authors.forename: Manuel
authors.initials: M
authors.lastname: Bernal-Sprekelsen
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009079:Mucociliary Clearance / Q000502:physiology*; D009296:Nasal Cavity / Q000601:surgery; D044583:Neuroendoscopy / Q000009:adverse effects*; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D012903:Smell / Q000502:physiology*; D013524:Surgical Flaps / Q000009:adverse effects*; D055815:Young Adult