Endoscopic vidian neurectomy: a prospective case series.
BACKGROUND
Chronic refractory vasomotor rhinitis (VMR) is a debilitating condition that causes significant impairment of quality of life. The purpose of this study is to investigate the efficacy and potential side effects of endoscopic vidian neurectomy as treatment for patients with VMR.


METHODS
This study was a prospective, intent-to-follow case series. Inclusion criteria were as follows: (1) patients with debilitating VMR refractory to medical therapy and with significant impact on quality of life; (2) negative allergy history and skin testing; and (3) negative computed tomography (CT) scan to rule out skull-base defect or cerebrospinal fluid (CSF) fistula. Patients underwent bilateral vidian neurectomy via a pterygomaxillary approach. Prior to surgery all patients underwent formal ophthalmologic testing to quantify preoperative ocular and lacrimal function. Ophthalmologic testing was repeated postoperatively at approximately 3 months. Patients also completed surveys regarding rhinologic outcomes including the Sinusitis Symptom Questionnaire (SSQ) and the 22-item Sino-Nasal Outcome Test (SNOT-22) at the following time points: preoperatively, and 1 week, 4 weeks, 12 weeks, 6 months, 1 year, and 2 years postsurgery. Descriptive statistics and analysis of variance (ANOVA) were undertaken.


RESULTS
Eleven patients (22 sides) underwent bilateral vidian neurectomy with pathologic confirmation of nerve section in all cases. Average follow-up was 19.4 months. Statistically and clinically significant improvement was measured for both the SSQ and the SNOT-22 and compared with the patients' baseline scores (p < 0.0001). Subscores for rhinorrhea and nasal congestions were also statistically significantly improved (p < 0.05). No incidence of permanent or measureable dry eye has been reported.


CONCLUSIONS
The data suggests that vidian neurectomy is an effective, safe, and definitive treatment for most patients with VMR refractory to medical treatment.
Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
Han
H
Zhang
Department of Surgery, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.
Damian C
DC
Micomonaco
Department of Otolaryngology-Head and Neck Surgery, University of Florida, Gainesville, FL.
Peter T
PT
Dziegielewski
Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.
Leigh J
LJ
Sowerby
Division of Ophthalmology, University of Alberta, Edmonton, Alberta, Canada.
Ezekiel
E
Weis
Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
Erin D
ED
Wright
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003391:Cranial Nerves / Q000601:surgery*; D003714:Denervation / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia; D019635:Neurosurgical Procedures / Q000379:methods*; D009666:Nose / Q000294:innervation*; D011446:Prospective Studies; D012223:Rhinitis, Vasomotor / Q000601:surgery*; D011795:Surveys and Questionnaires
endoscopic vidian neurectomy; nonallergic rhinitis; rhinorrhea; vasomotor rhinitis; vidian nerve