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Henry LE, Eide JG, Kshirsagar RS, Tong CCL, Kuan EC, Poonia SK, Storm PB, Palmer JN, Adappa ND. Incidence of Sinus Inflammation After Endoscopic Skull Base Surgery in the Pediatric Population. Laryngoscope 2022. [PMID: 36189938 DOI: 10.1002/lary.30415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/01/2022] [Accepted: 09/07/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The extended endonasal approach has been utilized in the resection of anterior skull base lesions in the pediatric population. There are unique challenges to these patients in the post-operative setting, including patient compliance with medical therapy and post-operative debridements, and a smaller nasal airway that may increase propensity toward scarring. Our objective for this study is to evaluate the incidence of post-operative radiographic inflammation in this patient population using the Lund-Mackay (LM) score. METHODS A single-center, retrospective review of pediatric patients undergoing endoscopic approach to the skull base between 2009 and 2021 was performed. Demographic and clinicopathologic data and pre- and post-operative imaging were analyzed. One-way ANOVA followed by Tukey multiple pairwise comparisons statistical tests were used to compare mean LM scores between groups. RESULTS Seventy-two patients (52 males, 20 females) were identified with a median follow-up of 27 months. All patients underwent an extended endonasal approach for resection of skull base lesions. The mean LM scores were compared between pre-operative MRI, first post-operative MRI > 30 days after surgery, and most recent post-operative MRI. One-way ANOVA was performed with significant differences noted between the groups (p < 0.001). Tukey multiple pairwise comparisons test was then performed and noted significant differences between the pre-operative and first post-operative LM (p < 0.0001) and the first post-operative and most recent LM (p < 0.0001). There was no significant difference noted between the pre-operative LM score and most recent LM score (p = 0.14). CONCLUSION Despite concerns regarding possible subsequent development of chronic rhinosinusitis following endoscopic skull base surgery in pediatric patients, the current study suggests that transient radiographic evidence of sinus inflammation can be seen up to six months postoperatively, which appears to resolve by approximately two years after surgery. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Laura E Henry
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jacob G Eide
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rijul S Kshirsagar
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Charles C L Tong
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Seerat K Poonia
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Phillip B Storm
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Gediz T, Gür EÖ. Clinical Significance of Nasal Pathologies in Transnasal Transsphenoidal Pituitary Surgery. World Neurosurg 2022; 164:e824-e829. [PMID: 35654330 DOI: 10.1016/j.wneu.2022.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND We evaluated the frequency of nasal pathologies and the significance of surgical access to the sellar region in patients who underwent an operation for sellar mass using the endonasal and microscopic transsphenoidal approaches. METHODS We retrospectively evaluated all patients who underwent surgery for pituitary macroadenoma using microscopic (n = 78) and endonasal (n = 20) transsphenoidal approaches. Patients' epicrisis, preoperative, and postoperative imaging as well as their operative notes were reviewed. Nasal pathologies and surgeries performed before or during the pituitary surgery were also documented. All endonasal surgeries were binostril and performed jointly by an ear, nose, and throat specialist and neurosurgeon. To determine the feasibility of endonasal and microscopic approaches, we developed an algorithm using the septum deviation classifications to determine the need for septoplasty. RESULTS The most common nasal pathology was septum deviation (n = 17; 17.3%). Of the other nasal pathologies, 6 cases (6%) were chronic sinusitis and 2 were (2.1%) middle turbinate bullosa. CONCLUSIONS The preoperative evaluation of patients undergoing endonasal transsphenoidal surgery by an ear, nose, and throat surgeon allows for the detection and treatment of nasal pathologies that may lead to serious perioperative and postoperative complications. Evaluating patients with septum deviation using our classification will help determine the necessity of preoperative or perioperative septum surgery, depending on the preferred pituitary surgical method.
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Affiliation(s)
- Tolga Gediz
- Department of Neurosurgery, Antalya Training and Research Hospital, Antalya, Turkey.
| | - Erdem Özer Gür
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Antalya Training and Research Hospital, Antalya, Turkey
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Lee JJ, Deutsch BC, Kallogjeri D, Pipkorn P, Schneider JS, Klatt-Cromwell CN. Chronic rhinosinusitis as a risk factor for intracranial and extracranial complications after endoscopic transsphenoidal surgery. Am J Otolaryngol 2022; 43:103188. [PMID: 34537507 PMCID: PMC9007068 DOI: 10.1016/j.amjoto.2021.103188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/30/2021] [Accepted: 08/26/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To elucidate whether chronic rhinosinusitis (CRS), usually an inflammatory-mediated rather than infectious process, is a risk factor for extracranial and intracranial complications after elective endoscopic transsphenoidal surgery (ETSS). MATERIALS AND METHODS A single-center retrospective cohort study of consecutive patients who underwent ETSS between January 2015 and July 2019 was performed, which included chart review and computed tomography assessment. CRS was defined by symptomatology and concurrent endoscopic or radiographic findings. RESULTS Of 292 subjects, 11% (n = 33) met criteria for CRS. Median difference in Lund-Mackay scores between the CRS and non-CRS groups was 3.0 (95% CI 2.0-4.0). Complications included acute rhinosinusitis requiring antibiotics (23%, 68/292), epistaxis (10%, 28/292), meningitis (1%, 3/292), cerebrospinal fluid (CSF) leak (7%, 20/292), revision sinonasal procedures (10%, 28/292), and frequent in-office debridement (13%, 39/292). CRS was strongly associated with postoperative acute rhinosinusitis (aRR 1.85, 95% CI 1.18-2.90) and frequent debridement (aRR 1.96, 95% CI 1.00-3.83). Conversely, CRS was not associated with epistaxis (aRR 1.52, 95% CI 0.62-3.72), postoperative CSF leak (aRR 0.91, 95% CI 0.24-3.44), or additional sinonasal procedures (aRR 0.70, 95% CI 0.21-2.29). The rate of meningitis was not significantly higher in the CRS cohort (difference 2.2%, 95% CI -1.0% to 14.5%). CONCLUSIONS CRS was a strong risk factor for acute rhinosinusitis and need for frequent in-office debridement after ETSS. It was not associated with other postoperative complications including epistaxis, CSF leak, or revision sinonasal procedures. CRS patients had a slightly higher rate of meningitis, which is likely not clinically meaningful.
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Affiliation(s)
- Jake J. Lee
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Brian C. Deutsch
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John S. Schneider
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Cristine N. Klatt-Cromwell
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Bao Q, Zhou Y, Zhang L. Effect of Xinyi Biyan Pill in Adjuvant Treatment of Patients with Chronic Rhinosinusitis and Its Influence on Serum Inflammatory Factors and Immune Function. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:2228803. [PMID: 34490054 PMCID: PMC8418552 DOI: 10.1155/2021/2228803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/06/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the effect of Xinyi Biyan Pill in adjuvant treatment of patients with chronic rhinosinusitis (CRS) and its influence on serum inflammatory factors and immune function. METHODS From January 2017 to April 2020, 112 CRS patients admitted to this hospital were randomly divided into the control group (n = 52) and the study group (n = 60). The control group was treated with endoscopic sinus surgery (ESS), after the operation, levofloxacin capsules were taken orally, budesonide nasal spray was given, and the nasal cavity was flushed with normal saline; on the basis of that mentioned above, the study group was treated with Xinyi Biyan Pill orally after the surgery. The clinical efficacy and the symptom relief time of nasal congestion and runny nose, hyposmia, mucosal edema, and vesicles disappearance of the two groups after treatment were observed; the serum inflammatory factors' (C-reactive protein (CRP), interleukin-6 (IL-6), and interleukin-8 (IL-8)) and immune function indexes' (total immunoglobulin E (TIgE), eosinophil cationic protein (ECP), CD3+, CD4+, and CD4+/CD8+) expression levels before and after treatment in the two groups were detected; the recurrence of CRS after 1 year of treatment in the two groups was recorded. RESULT After treatment, the total clinical effective rate of the study group (92.98%) was significantly higher than that of the control group (78.00%) (P < 0.05). After treatment, the symptom relief time of nasal congestion and runny nose, hyposmia, mucosal edema, and vesicle disappearance in the study group was shorter than that in the control group (P < 0.05). After treatment, the expression levels of serum CRP, IL-6, and IL-8 in the two groups were significantly lower than those before treatment, and the study group was significantly lower than the control group (P < 0.05). After treatment, the expression levels of serum TIgE and ECP of the two groups were significantly lower than those before treatment, the expression levels of serum CD3+, CD4+, and CD4+/CD8+ of the two groups were significantly higher than those before treatment, and the study group had significant changes compared with the control group (P < 0.05). After 1 year of treatment, the recurrence rate of CRS in the study group (1.79%) was significantly lower than that in the control group (12.00%) (P < 0.05). CONCLUSION Xinyi Biyan Pill has a significant clinical effect in adjuvant treatment of CRS patients. It can effectively reduce the expression level of serum inflammatory factors, improve the body's immune function, and prevent short-term recurrence. It is worthy of clinical promotion.
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Affiliation(s)
- Qingfu Bao
- Department of ENT & HN Surgery, Shao Yifu Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, Zhejiang 310000, China
- Department of ENT & HN Surgery, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang 310000, China
| | - Yu Zhou
- Department of ENT & HN Surgery, The 903th Hospital of PLA Joint Logistics Support Force, Hangzhou, Zhejiang 31000, China
| | - Lei Zhang
- Department of ENT & HN Surgery, Shao Yifu Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, Zhejiang 310000, China
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Lee CH, Ikeda AK, Patel S, Levy JM, Patel ZM, Solares CA, Oyesiku N, Wise SK. Risk Factors for Rhinosinusitis After Endoscopic Transsphenoidal Adenomectomy. Am J Rhinol Allergy 2020; 35:348-352. [PMID: 32921135 DOI: 10.1177/1945892420958549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Patients undergoing endoscopic transsphenoidal adenomectomy (eTSA) for pituitary tumors are at risk for postoperative complications, including rhinosinusitis. We aimed to determine if preoperative sinonasal disease is a risk factor for postoperative rhinosinusitis (PRS). STUDY DESIGN Retrospective review. SETTING Tertiary academic center in U.S. SUBJECTS AND METHODS Patients with a diagnosis of pituitary adenoma who underwent eTSA between 2007-2016. PRS patients were matched to non-PRS patients or sex, age, tumor size, skull base reconstruction with intranasal tissue grafting, and concurrent septoplasty. Groups were statistically analyzed for potential preoperative risk factors of sinonasal disease (patient-reported, radiographic, endoscopic). RESULTS 49 of 987 patients who underwent eTSA developed PRS (44.9% male, 71.4% Caucasian, mean age 49.3y). On analysis of individual risk factors, there was a significantly higher proportion of patients with a history of prior sinonasal surgery in the PRS group than the non-PRS group (25.5% vs. 6.5%, p = 0.01); however, this group difference became insignificant on multivariate analysis. There were no significant group differences with regard to history of sinus infections, nasal symptoms, seasonal allergies, radiographic abnormalities, or sinonasal disease on endoscopy. CONCLUSION This is the first study to investigate preoperative sinonasal disease as a risk factor for PRS after eTSA. The risk factors considered did not demonstrate definitive risk for PRS, although a history of prior sinonasal surgery should be investigated further.
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Affiliation(s)
- Clara H Lee
- Emory University School of Medicine, Atlanta, Georgia
| | - Allison K Ikeda
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
| | - Shubham Patel
- Emory University School of Medicine, Atlanta, Georgia
| | - Joshua M Levy
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California
| | - C Arturo Solares
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia
| | - Nelson Oyesiku
- Department of Neurological Surgery, Emory University, Atlanta, Georgia.,Department of Medicine, Emory University, Atlanta, Georgia
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia
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Shah J, Cappello ZJ, Roxbury C, Tang D, Woodard TD, Kshettry VR, Recinos PF, Sindwani R. Prevalence and Clinical Significance of Radiographic Sinus Disease on Preoperative Computed Tomography Imaging in the Endoscopic Skull Base Surgery Population. Am J Rhinol Allergy 2020; 35:239-244. [PMID: 32781830 DOI: 10.1177/1945892420949130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Endoscopic skull base surgery (ESBS) provides a safe, minimally invasive approach to treat benign and malignant skull base lesions. The significance of concomitant sinonasal pathology on imaging in patients undergoing ESBS and its effect on perioperative management is not well described. We sought to identify the prevalence and clinical significance of incidentally found radiographic sinus disease on preoperative imaging in patients undergoing ESBS and provide a protocol for management of these patients. DESIGN A retrospective chart review was performed of consecutive patients who underwent ESBS from January 1, 2016 to June 30, 2018. Preoperative computed tomography (CT) scans were reviewed and scored using the Lund-Mackay (LM) staging system. Preoperative nasal endoscopy findings were analyzed. Any preoperative treatment based on these findings and changes in intraoperative management were examined. RESULTS A total of 156 patients (81 women, 74 men) who underwent ESBS were reviewed. The average LM score was 2 ± 2.7 (range: 0-12). A total of 94 patients (60.3%) had evidence of radiographic sinus disease (LM score > 0) and 23 patients (14.7%) had presence of sphenoid sinus disease. Seven patients (4.5%) were treated preoperatively based on CT and/or nasal endoscopy findings. All patients who received preoperative treatment had evidence of sinus disease on imaging with an average score of 4.7 and were evaluated and treated within 1-2 weeks prior to ESBS. One patient had ESBS postponed until endoscopic sinus surgery was performed for extensive chronic rhinosinusitis (CRS) findings on imaging. CONCLUSION A review of preoperative imaging in patients undergoing ESBS can help identify concurrent sinonasal disease, which has the potential to alter preoperative as well as intraoperative management in these patients. We report a diligent but conservative approach for the treatment of concomitant CRS in the ESBS population with decision for preoperative treatment guided by various factors.
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Affiliation(s)
- Janki Shah
- Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Zachary J Cappello
- Department of Otolaryngology-Head and Neck Surgery, Charlotte Eye, Ear, Nose and Throat, Charlotte, North Carolina
| | - Christopher Roxbury
- Rhinology and Endoscopic Skull Base Surgery, Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Dennis Tang
- Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Troy D Woodard
- Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.,Minimally Invasive Cranial Base and Pituitary Surgery, Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Varun R Kshettry
- Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.,Minimally Invasive Cranial Base and Pituitary Surgery, Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Pablo F Recinos
- Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.,Minimally Invasive Cranial Base and Pituitary Surgery, Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Raj Sindwani
- Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.,Minimally Invasive Cranial Base and Pituitary Surgery, Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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