title: Avoidance of postoperative epistaxis and anosmia in endonasal endoscopic skull base surgery: a technical note.
abstract: BACKGROUND
  Most endoscopic transsphenoidal approaches jeopardize the sphenopalatine artery and septal olfactory strip (SOS), increasing the risk of postoperative anosmia and epistaxis while precluding the ability to raise pedicled nasoseptal flaps (NSF). We describe a bilateral "rescue flap" technique that preserves the mucosa containing the nasal-septal vascular pedicles and the SOS. This approach can reduce the risk of postoperative complications, including epistaxis and anosmia.
  
  
  METHODS
  A retrospective analysis was conducted of all patients who underwent endoscopic transsphenoidal surgery with preservation of both sphenopalatine vascular pedicles and SOS. In a recent subset of patients, olfactory assessment was performed.
  
  
  RESULTS
  Of 174 consecutive operations performed in 161 patients, bilateral preservation of the sphenopalatine vascular pedicle and SOS was achieved in 139 (80 %) operations, including 31 (22 %) with prior transsphenoidal surgery. Of the remaining 35 operations, 18 had a planned formal NSF and 17 had prior surgery or extensive lesions precluding use of this technique. Of pituitary adenomas, RCCs or sellar arachnoid cysts, 118 (94 %) underwent this approach, including 91 % of patients who had prior surgery. Preoperative olfaction function was maintained in 97 % of patients that were tested. None of the patients had postoperative arterial epistaxis.
  
  
  CONCLUSIONS
  Preservation of bilateral sphenopalatine vascular pedicles and the SOS is feasible in over 90 % of patients undergoing endonasal endoscopic surgery for pituitary adenomas and RCCs. This approach, while not hindering exposure or limiting instrument maneuverability, preserves the nasoseptal vasculature for future NSF use if needed and appears to minimize the risks of postoperative arterial epistaxis and anosmia.
authors.affiliation: Saint Johns Medical Center, John Wayne Cancer Institute, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USA.
authors.forename: Chester F
authors.initials: CF
authors.lastname: Griffiths
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Cutler
authors.forename: Huy T
authors.initials: HT
authors.lastname: Duong
authors.forename: Gal
authors.initials: G
authors.lastname: Bardo
authors.forename: Kian
authors.initials: K
authors.lastname: Karimi
authors.forename: Garni
authors.initials: G
authors.lastname: Barkhoudarian
authors.forename: Ricardo
authors.initials: R
authors.lastname: Carrau
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Kelly
mesh_terms: D000328:Adult; D000368:Aged; D002536:Cerebral Arteries / Q000293:injuries; D015331:Cohort Studies; D004724:Endoscopy / Q000009:adverse effects*; D004844:Epistaxis / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D000857:Olfaction Disorders / Q000517:prevention & control*; D009831:Olfactory Mucosa / Q000293:injuries / Q000473:pathology; D011183:Postoperative Complications / Q000517:prevention & control*; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply