Sinonasal morbidity following endoscopic endonasal skull base surgery

Abstract

Open transcranial surgery has long served as the traditional approach for resecting tumors and other lesions in the skull base. However, endoscopic endonasal skull base surgery (EESBS) has emerged as a credible alternative. This paper provides insight on the sinonasal morbidity in patients undergoing EESBS. A literature review was performed by searches of MEDLINE database to provide further insight on sinonasal morbidity associated with EESBS, with a particular focus on published incidence rates and patterns of complication. We identified only articles that reported the incidence of sinonasal morbidity and complications as the major outcome of the studies. The most common sinonasal morbidity symptoms are nasal crusting (50.8%), nasal discharge (40.4%), nasal airflow blockage (40.1%) followed by disturbances in olfaction (26.7%). The incidence of mucocele formation is 8%, and this is significantly increased in pediatric patients up to 25% (range, 14-50%). Epistaxis appears to be a rare event, often times not found in some case series. Some studies suggested less morbidity if the middle turbinate can be preserved, a finding that must be balanced with the need for sufficient exposure on larger cases. Sinonasal morbidity following endoscopic endonasal skull base surgery has the potential to adversely impact patient quality of life, with nasal crusting and discharge being the two most common symptoms. Morbidity signs and symptoms usually resolve within 3-4 months, however symptoms can persist for longer with more complex surgeries. The rate of mucocele formation is higher in pediatric patients, with special attention required in graft positioning for this population in particular.

Keywords: Endonasal; Endoscopic; Nasal morbidity; Quality of life; Skull base.