The Expanded Endonasal Approach: Does Greater Exposure Change Rhinologic Outcomes?

Objective: This study was aimed to investigate the postoperative sinonasal outcomes of patients who have undergone a widely expansive expanded endonasal approach.

Methods: A retrospective chart review of patients who had undergone a widely expansive expanded endonasal approach procedure by a single skull base surgery team between June 1, 2016 and June 1, 2019 was completed. Inclusion criteria were only those patients that completed a Sinonasal outcome test-22 (SNOT-22). Our approach was characterized by either a uninostril or a binostril technique with a posterior septectomy, depending on the lesion location. If a skull base defect was present, a nasoseptal or pericranial flap was used. An abdominal fat graft was also employed as a biologic dressing when an intraoperative cerebrospinal fluid (CSF) leak presented. Patients were seen preoperatively and 1, 2, and 4 weeks postoperatively. They were also seen for follow-up at 3, 6, and 12 months postoperatively. Postoperative care included debridements at 1-, 2-, and 4-week follow-up clinic visits. Each patient had nasal packing and antibiotics postoperatively. Packing was removed within the first week after surgery. Once packing was removed, patients were instructed to use a NeilMed rinse bottle with saline rinse at minimum six times per day until advised to discontinue usage. Fat grafts were removed at the third postoperative visit, 4 weeks after surgery. Preoperative SNOT scores were compared with scores collected at each postoperative clinic visit. The patient population was divided between individuals that underwent a uninostril approach or a binostril approach to determine if there was any difference between the two groups 6 months post-surgery. Chi-squared analysis was also used to compare possible differences in patient outcomes based on collected patient demographic information including gender, age, whether they were diabetic, depressed, anxious, and using immunocompromising or topical medications.

Results: Only 139 skull base surgeries with an associated SNOT score were completed during the 3-year review period. There was no significant difference in total, rhinological or quality of life patient outcomes, measured via SNOT-22 scores, at least 6 months postoperatively when compared with preoperative scores (p = 0.157). Comparison of uninostril vs. binostril approaches also did not show any significant difference in outcomes at least 6 months after surgery (p = 0.5353). There was no statistical difference between groups based on reconstruction method.

Conclusion: The widely expansive expanded endonasal approach with active postoperative care does not appear to affect long-term rhinological or quality of life patient outcomes. The benefits of our approach include increased operative dexterity, topical delivery of postoperative medication, and visualization of pathology.