Endoscopic unilateral transethmoid‐paraseptal approach to the central skull base

Abstract

Objectives: The endoscopic technique in transnasal skull base surgery offers optimal visualization and free manipulation in the surgical field. However, it may cause approach-related sinonasal injury, influencing patients' quality of life (QOL). To minimize rhinological morbidity without restrictions in surgical manipulation and tumor resection, we introduced the unilateral transethmoidal-paraseptal approach. In this article, we analyzed the long-term results and sinonasal outcome of this technique. Study Design: Retrospective analysis of medical records. Methods: Forty-two consecutive patients underwent surgery between June 2010 and March 2014 using the transethmoid-paraseptal approach. Perioperative work-up included neurological, radiological, endocrinological, ophthalmological, and rhinological analysis. Patients' preoperative, 1-month and 1-year postoperative QOL was measured using the Sino-Nasal Outcome Test (SNOT-22). Results: At all individuals, a unilateral transethmoid-paraseptal approach was performed. Removal of the turbinates, posterior septal resection or a conversion to biportal surgery could be avoided in all cases. There were no intraoperative neurovascular complications. All patients had a notable improvement in any disease-related symptoms, as well as by objective criteria. Complete tumor resection was aimed in 39 cases and achieved in 31 of them. The SNOT-22 scores transiently worsened 1 month after surgery and non-significantly improved after 1 year, compared with the preoperative status. A subgroup of 7 patients with preoperative sinonasal disease evidence showed continuous significant improvement (p < .05) of SNOT-22 scores across time. The smell screening tests showed no significant difference across time. Conclusion: The described approach allows safe removal of various skull base lesions without deterioration in sinonasal QOL and smell function. Level of Evidence: 4.