Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base.
BACKGROUND
The large increase in the number of transnasal endoscopic skull base surgeries is a consequence of greater knowledge of the anatomic region, the development of specific materials and instruments, and especially the use of the nasoseptal flap as a barrier between the sinus tract (contaminated cavity) and the subarachnoid space (sterile area), reducing the high risk of contamination.


OBJECTIVE
To assess the otorhinolaryngologic complications in patients undergoing endoscopic surgery of the skull base, in which a nasoseptal flap was used.


METHODS
This was a retrospective study that included patients who underwent endoscopic skull base surgery with creation of a nasoseptal flap, assessing for the presence of the following post-surgical complications: cerebrospinal fluid leak, meningitis, mucocele formation, nasal synechia, septal perforation (prior to posterior septectomy), internal nasal valve failure, epistaxis, and olfactory alterations.


RESULTS
The study assessed 41 patients undergoing surgery. Of these, 35 had pituitary adenomas (macro- or micro-adenomas; sellar and suprasellar extension), three had meningiomas (two tuberculum sellae and one olfactory groove), two had craniopharyngiomas, and one had an intracranial abscess. The complications were cerebrospinal fluid leak (three patients; 7.3%), meningitis (three patients; 7.3%), nasal fossa synechia (eight patients; 19.5%), internal nasal valve failure (six patients; 14.6%), and complaints of worsening of the sense of smell (16 patients; 39%). The olfactory test showed anosmia or hyposmia in ten patients (24.3%). No patient had mucocele, epistaxis, or septal perforation.


CONCLUSIONS
The use of the nasoseptal flap has revolutionized endoscopic skull base surgery, making the procedures more effective and with lower morbidity compared to the traditional route. However, although mainly transient nasal morbidities were observed, in some cases, permanent hyposmia and anosmia resulted. An improvement in this technique is therefore necessary to provide a better quality of life for the patient, reducing potential complications.
Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSC-SP), São Paulo, SP, Brazil. Electronic address: landini37@hotmail.com.
Ricardo Landini Lutaif
RLL
Dolci
Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSC-SP), São Paulo, SP, Brazil.
Marcel Menon
MM
Miyake
Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSC-SP), São Paulo, SP, Brazil.
Daniela Akemi
DA
Tateno
Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSC-SP), São Paulo, SP, Brazil.
Natalia Amaral
NA
Cançado
Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSC-SP), São Paulo, SP, Brazil.
Carlos Augusto Correia
CAC
Campos
Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSC-SP), São Paulo, SP, Brazil; Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Cirurgia, Disciplina de Neurocirurgia, São Paulo, SP, Brazil.
Américo Rubens Leite
ARL
Dos Santos
Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSC-SP), São Paulo, SP, Brazil.
Paulo Roberto
PR
Lazarini
D000293:Adolescent; D000328:Adult; D000368:Aged; D001922:Brain Abscess / Q000601:surgery*; D003397:Craniopharyngioma / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D009300:Nasal Septum / Q000601:surgery*; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult
Base do crânio; Complications; Complicações; Endonasal; Endoscopic; Endoscópica; Nasoseptal flap; Otorhinolaryngologic; Otorrinolaringológicas; Retalho nasoseptal; Skull base