Assistant Professor Johns Hopkins University School of Medicine Baltimore, MD, US
Introduction: Despite its many advantages, use of the endonasal corridor during surgery presents unique technical challenges and potential tissue trauma. Given that use of an endonasal protective device may facilitate use of the endonasal corridor in EESBS, we aimed to assess the utility of a nasal access guide (NAG), in preventing intra- and post-operative mucosal injury.
Methods: Patients with sellar-based pathology were prospectively enrolled and sequentially underwent ESSBS with or without use of the NAG in a 2:1 fashion (intervention:control). Operative video clips at the culmination of the surgical exposure and following tumor resection were captured. Blinded surgeons, 2 otolaryngologists and 2 neurosurgeons, assessed mucosal trauma using a Likert scale (0-4) at both time points.
Pre- and post-operative endoscopic assessments of the sinonasal cavity were completed using the Lund-Kennedy endonasal score (LKES). Additionally, ASK Nasal-12 surveys were administered to each patient as a method of assessing Quality of Life (QOL). Chi-square testing was used to assess differences in LKES and ASK-Nasal-12 outcomes with P-values of < 0.05 being considered statistically significant.
Results: A total of 33 patients were included in the study. Participants were predominantly female (69.7%) and white (75.75%). There were no significant differences in age, sex, race, tumor diagnosis or prior medical history between NAG and non-NAG cohorts.
Patients with intraoperative NAG placement were less likely to experience intraoperative sinonasal tissue injury relative to controls as reported by blinded otolaryngologists (0.35 vs. 0.58, p = 0.042). Otolaryngology and neurosurgeons were in agreement that patients with intraoperative NAG were more likely to have unchanged or improved sinonasal quality scores following tumor resection compared to controls (48.9% vs. 34.7%, p = 0.050).
Conclusion : This pilot study suggests that use of NAGs during EESBS may minimize intraoperative sinonasal mucosal trauma. Larger studies with longer follow-ups are warranted to validate these findings.
