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Weiland T, Gellner V, Pondorfer P, Hortobagyi D, Maitz E, Kiss P, Borenich A, Reininghaus EZ, Thurnher D, Tomazic PV. Endoscopic trans-sphenoidal pituitary surgery does not impact postoperative nasal quality of life. Eur Arch Otorhinolaryngol 2024; 281:245-256. [PMID: 37650929 PMCID: PMC10764578 DOI: 10.1007/s00405-023-08203-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE The aim of this prospective longitudinal study was to assess both subjective quality of life using questionnaires and objective examination of nasal function with regard to olfaction, nasal air flow and mucociliary clearance in patients after minimally invasive, turbinate-preserving endoscopic transnasal trans-sphenoidal pituitary surgery. METHODS Patients undergoing endoscopic transnasal pituitary surgery were recruited prospectively and examined during three study visits, preoperatively and 3 and 6 months postoperatively. We examined nasal function using sniffin' sticks test, rhinomanometry, saccharin transit time test, and endoscopic and radiological scores. In addition, the influence on subjective quality of life and mental health was recorded using the Sinonasal-Outcome-Test-20 (SNOT-20) and the Hospital-Anxiety-and-Depression-Scale (HADS). RESULTS 20 patients undergoing endoscopic pituitary tumor resections were included. No significant changes in olfaction or mucociliary clearance were noted. Nasal air flow showed a tendency to increase in the postoperative course lacking significance. Both the endoscopy and the radiological scores showed a significant deterioration, especially after 3 months, with a trend towards improvement over time. However, neither the SNOT-20 nor the HADS showed significant changes compared to baseline. CONCLUSIONS Our concept of minimally invasive endoscopic tumor resections on the pituitary gland with preservation of nasal turbinates shows low morbidity for the patient. Despite objectifiable surgery-associated changes in the nose, nasal physiology in terms of smell, airflow and mucociliary clearance can be preserved and the subjective quality of life of our patients remains stable.
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Affiliation(s)
- Thomas Weiland
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria.
| | - Verena Gellner
- Department of Neurosurgery, Medical University of Graz, Graz, Austria
| | - Prisca Pondorfer
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - David Hortobagyi
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Emanuel Maitz
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Peter Kiss
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Andrea Borenich
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Eva Z Reininghaus
- Department for Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Dietmar Thurnher
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Peter Valentin Tomazic
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
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Chmielewski WX, Walbrodt S, Rauschenbach L, Chihi M, Gembruch O, Darkwah Oppong M, Schroer S, Wrede KH, Dammann P, Jabbarli R, Kreitschmann-Andermahr I, Sato T, Unger N, Mattheis S, Sure U, Ahmadipour Y. Pre-Surgery Patient Health Contributes to Aggravated Sino-Nasal Outcome and Quality of Life after Pituitary Adenomectomy. Medicina (B Aires) 2023; 59:medicina59010127. [PMID: 36676751 PMCID: PMC9864056 DOI: 10.3390/medicina59010127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
Objectives: The transphenoidal bi-nostril endoscopic resection of pituitary adenomas is regarded as a minimally invasive treatment nowadays. However, sino-nasal outcome and health-related quality of life (HRQoL) might still be impaired after the adenomectomy, depending on patients' prior medical history and health status. A systematic postoperative comparison is required to assess differences in perceived sino-nasal outcome and HRQoL. Methods: In this single-center observational study, we collected data from 81 patients, operated between August 2016 and August 2021, at a 3-6-month follow-up after adenomectomy. We employed the sino-nasal outcome test for neurosurgery (SNOT-NC) and the HRQoL inventory Short Form (SF)-36 to compare sino-nasal and HRQoL outcome in patients with or without allergies, previous nose surgeries, presence of pain, snoring, sleep apnea, usage of continuous positive airway pressure (cpap), and nose drop usage. Results: At the 3-6-month follow-up, patients with previous nasal surgery showed overall reduced subjective sino-nasal health, increased nasal and ear/head discomfort, increased visual impairment, and decreased psychological HRQoL (all p ≤ 0.026) after pituitary adenomectomy. Patients with pain before surgery showed a trend-level aggravated physical HRQoL (p = 0.084). Conclusion: Our data show that patients with previous nasal surgery have an increased risk of an aggravated sino-nasal and HRQoL outcome after pituitary adenomectomy. These patients should be thoroughly informed about potential consequences to induce realistic patient expectations. Moreover, the study shows that patients with moderately severe allergies, snoring, and sleep apnea (± cpap) usually do not have to expect a worsened sino-nasal health and HRQoL outcome.
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Affiliation(s)
- Witold X. Chmielewski
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
- Correspondence: ; Tel.: +49-201-723-84235
| | - Sebastian Walbrodt
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Laurèl Rauschenbach
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Mehdi Chihi
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Oliver Gembruch
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Sebastian Schroer
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Karsten H. Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Ilonka Kreitschmann-Andermahr
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Taku Sato
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
- Department of Neurosurgery, Fukushima Medical University, Fukushima 960-1247, Japan
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, 45147 Essen, Germany
| | - Stefan Mattheis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, 45147 Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
| | - Yahya Ahmadipour
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, 47147 Duisburg, Germany
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Mattheis S, Schlüter A, Stähr K, Holtmann L, Höing B, Hussain T, Kanaan O, Eckstein A, Lang S. First Use of a New Robotic Endoscope Guiding System in Endoscopic Orbital Decompression. EAR, NOSE & THROAT JOURNAL 2019; 100:443S-448S. [PMID: 31690110 DOI: 10.1177/0145561319885803] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Over the last years, robot-assisted surgery gained in importance in head and neck surgery. In our study, we used a new robotic endoscope guiding system in patients undergoing endoscopic balanced orbital decompression. The aim of the study is to evaluate the feasibility and benefit of a robotic arm in endoscopic orbital surgery. METHODS The Medineering Robotic Endoscope Guiding System is a robotic arm designed for holding an endoscope during interventions. An endoscope equipped with a 4K camera was attached at the tip of the robotic arm and placed in the surgical field. The surgeon controlled the movements of the endoscope with foot pedal. Eight patients underwent balanced endoscopic orbital decompression showing typical symptoms of Graves' orbitopathy preoperatively. Balanced decompression was performed via a combined approach transnasally and laterally via a small skin incision. RESULTS Attaching the endoscope to the robotic guiding system and placing it in the nasal cavity were relatively simple procedures. Setup time was less than 10 minutes. Tool motion and control using the foot pedal were comfortable and adequately precise. Movements of the attached endoscope inside the nose were feasible and allowed 2-hand surgery. The patients did not show any adverse events or complications. CONCLUSION The Medineering Robotic Endoscope Guiding System seems to be a safe and effective support in endoscopic skull base surgery especially for orbital decompression, thus allowing 2-hand or even 4-hand settings. To the best of our knowledge, this is the first study describing the successful application of a robotic system in orbital surgery.
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Affiliation(s)
- Stefan Mattheis
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Anke Schlüter
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Kerstin Stähr
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Laura Holtmann
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Benedikt Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Timon Hussain
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Oliver Kanaan
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Anja Eckstein
- Department of Ophthalmology, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
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