Morbidity in the postoperative follow-up of endoscopic anterior skull base surgery

Introduction: Endoscopic access to the sellar region by videoendoscopy shows a low rate of surgical complications, with findings that indicate risk factors for reducing morbidities during and after the postoperative period. Objective: To evaluate, over a nine-year period, the acquisition of skills b...

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Autores principales:	Gustavo Lara Rezende, Oswaldo Ribeiro Marquez Neto, Selma Aparecida Souza Kückelhaus
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Skull base surgery Pituitary adenoma Minimally invasive Nasal endoscopic surgery Otorhinolaryngology RF1-547
Acceso en línea:	https://doaj.org/article/18e3209954bf49b6b250f9b5aa4c758c
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spelling	oai:doaj.org-article:18e3209954bf49b6b250f9b5aa4c758c2021-11-06T04:23:42ZMorbidity in the postoperative follow-up of endoscopic anterior skull base surgery1808-869410.1016/j.bjorl.2020.02.006https://doaj.org/article/18e3209954bf49b6b250f9b5aa4c758c2021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S1808869420300318https://doaj.org/toc/1808-8694Introduction: Endoscopic access to the sellar region by videoendoscopy shows a low rate of surgical complications, with findings that indicate risk factors for reducing morbidities during and after the postoperative period. Objective: To evaluate, over a nine-year period, the acquisition of skills by the anterior skull base surgical team, according to the time of elimination of nasal crusts and/or the presence of morbidities in the postoperative follow-up of individuals treated in a tertiary public hospital. Methods: After confirming the diagnosis of skull base pathologies, the individuals in this study underwent endoscopic surgery according to the rostrocaudal or coronal axis. For the skull base reconstruction, the nasoseptal flap (associated or not with fascia lata with thigh fat) or free graft was used; clinical follow-up of individuals occurred for a minimum period of 12 months. To assess the impact of the surgical approach on patient clinical evolution, qualitative data related to smoking, post-nasal discharge, nasal flow, smell, taste, clinical symptoms of headache, cranial paresthesia, comorbidities and postoperative morbidities were obtained. Results: The most frequent diagnosis was pituitary macroadenoma (84.14%). The mean absence of crusts in this cohort was 124.45 days (confidence interval 95% = 119.50–129.39). There was a low cerebrospinal fluid fistula rate (3%). Reconstruction with the nasoseptal flap with a fat graft was an independent variable that recorded the highest mean time for the elimination of nasal crusts (=145 days, confidence interval 95% = 127.32–162.68). Allergic rhinitis and smoking were shown to be the most important and independent variables that increased the mean time to eliminate nasal crusts. Conclusion: The mean time to eliminate nasal crusts did not change over the years during which the procedures were performed, demonstrating the adequate training of the surgical team. Debridement and nasal irrigation with saline solutions should be performed more frequently and effectively in patients with allergic rhinitis, smokers and those who received the nasoseptal flap and fascia lata graft with autologous fat.Gustavo Lara RezendeOswaldo Ribeiro Marquez NetoSelma Aparecida Souza KückelhausElsevierarticleSkull base surgeryPituitary adenomaMinimally invasiveNasal endoscopic surgeryOtorhinolaryngologyRF1-547ENBrazilian Journal of Otorhinolaryngology, Vol 87, Iss 6, Pp 689-694 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Skull base surgery Pituitary adenoma Minimally invasive Nasal endoscopic surgery Otorhinolaryngology RF1-547
spellingShingle	Skull base surgery Pituitary adenoma Minimally invasive Nasal endoscopic surgery Otorhinolaryngology RF1-547 Gustavo Lara Rezende Oswaldo Ribeiro Marquez Neto Selma Aparecida Souza Kückelhaus Morbidity in the postoperative follow-up of endoscopic anterior skull base surgery
description	Introduction: Endoscopic access to the sellar region by videoendoscopy shows a low rate of surgical complications, with findings that indicate risk factors for reducing morbidities during and after the postoperative period. Objective: To evaluate, over a nine-year period, the acquisition of skills by the anterior skull base surgical team, according to the time of elimination of nasal crusts and/or the presence of morbidities in the postoperative follow-up of individuals treated in a tertiary public hospital. Methods: After confirming the diagnosis of skull base pathologies, the individuals in this study underwent endoscopic surgery according to the rostrocaudal or coronal axis. For the skull base reconstruction, the nasoseptal flap (associated or not with fascia lata with thigh fat) or free graft was used; clinical follow-up of individuals occurred for a minimum period of 12 months. To assess the impact of the surgical approach on patient clinical evolution, qualitative data related to smoking, post-nasal discharge, nasal flow, smell, taste, clinical symptoms of headache, cranial paresthesia, comorbidities and postoperative morbidities were obtained. Results: The most frequent diagnosis was pituitary macroadenoma (84.14%). The mean absence of crusts in this cohort was 124.45 days (confidence interval 95% = 119.50–129.39). There was a low cerebrospinal fluid fistula rate (3%). Reconstruction with the nasoseptal flap with a fat graft was an independent variable that recorded the highest mean time for the elimination of nasal crusts (=145 days, confidence interval 95% = 127.32–162.68). Allergic rhinitis and smoking were shown to be the most important and independent variables that increased the mean time to eliminate nasal crusts. Conclusion: The mean time to eliminate nasal crusts did not change over the years during which the procedures were performed, demonstrating the adequate training of the surgical team. Debridement and nasal irrigation with saline solutions should be performed more frequently and effectively in patients with allergic rhinitis, smokers and those who received the nasoseptal flap and fascia lata graft with autologous fat.
format	article
author	Gustavo Lara Rezende Oswaldo Ribeiro Marquez Neto Selma Aparecida Souza Kückelhaus
author_facet	Gustavo Lara Rezende Oswaldo Ribeiro Marquez Neto Selma Aparecida Souza Kückelhaus
author_sort	Gustavo Lara Rezende
title	Morbidity in the postoperative follow-up of endoscopic anterior skull base surgery
title_short	Morbidity in the postoperative follow-up of endoscopic anterior skull base surgery
title_full	Morbidity in the postoperative follow-up of endoscopic anterior skull base surgery
title_fullStr	Morbidity in the postoperative follow-up of endoscopic anterior skull base surgery
title_full_unstemmed	Morbidity in the postoperative follow-up of endoscopic anterior skull base surgery
title_sort	morbidity in the postoperative follow-up of endoscopic anterior skull base surgery
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/18e3209954bf49b6b250f9b5aa4c758c
work_keys_str_mv	AT gustavolararezende morbidityinthepostoperativefollowupofendoscopicanteriorskullbasesurgery AT oswaldoribeiromarquezneto morbidityinthepostoperativefollowupofendoscopicanteriorskullbasesurgery AT selmaaparecidasouzakuckelhaus morbidityinthepostoperativefollowupofendoscopicanteriorskullbasesurgery
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Morbidity in the postoperative follow-up of endoscopic anterior skull base surgery

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