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J Neurol Surg B Skull Base 2022; 83(06): 602-610
DOI: 10.1055/s-0042-1749654
Review Article

Optimizing Quality of Life and Minimizing Morbidity through Nasal Preservation in Endoscopic Skull Base Surgery: A Contemporary Review

Carlos Pinheiro-Neto
1   Department of Otolaryngology—Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
3   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Nicholas R. Rowan 
2   Department of Otolaryngology—Head & Neck Surgery, Johns Hopkins University, Baltimore, Maryland, United States
,
Maria Peris Celda
1   Department of Otolaryngology—Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
3   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Debraj Mukherjee 
4   Department of Neurologic Surgery, Johns Hopkins University, Baltimore, Maryland, United States
,
Jamie J. Van Gompel 
1   Department of Otolaryngology—Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
3   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Garret Choby 
1   Department of Otolaryngology—Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
3   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
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Abstract

Introduction Endoscopic endonasal approaches (EEAs) are increasingly utilized for intracranial pathology. As opposed to sinonasal tumors, the nasal cavity is being used as a corridor to access these intracranial tumors but is not the site of primary surgical intent. Accordingly, there has been recent interest in preserving intranasal structures not directly involved by tumor and improving postoperative sinonasal quality of life (QOL).

Objectives The aim of the study is to highlight recent advances in EEA techniques focused on improving sinonasal QOL including turbinate preservation, reducing the morbidity of reconstructive techniques, and the development of alternative minimally invasive EEA corridors.

Methods The method of the study involves contemporary literature review and summary of implications for clinical practice.

Results Nasoseptal flap (NSF) harvest is associated with significant morbidity including septal perforation, prolonged nasal crusting, and external nasal deformities. Various grafting and local rotational flaps have demonstrated the ability to significantly limit donor site morbidity. Free mucosal grafts have re-emerged as a reliable reconstructive option for sellar defects with an excellent sinonasal morbidity profile. Middle turbinate preservation is achievable in most EEA cases and has not been shown to cause postoperative obstructive sinusitis. Recently developed minimally invasive EEA techniques such as the superior ethmoidal approach have been described to better preserve intranasal structures while allowing intracranial access to resect skull base tumors and have shown promising sinonasal QOL results.

Conclusion This contemporary review discusses balancing effective skull base reconstructive techniques with associated morbidity, the role of turbinate preservation in EEA, and the development of unique EEA techniques that allow for increased nasal structure preservation.

Keywords

endoscopic skull base surgery - expanded endonasal approach - nasal preservation - turbinates - nasoseptal flap - free mucosal graft - CSF leak - sinonasal malignancy - chordoma - olfaction - quality of life


Publication History

Received: 21 September 2021

Accepted: 21 April 2022

Article published online:
09 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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