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Avoidance of postoperative epistaxis and anosmia in endonasal endoscopic skull base surgery: a technical note

  • Technical Note - Neurosurgical Techniques
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Abstract

Background

Most endoscopic transsphenoidal approaches jeopardize the sphenopalatine artery and septal olfactory strip (SOS), increasing the risk of postoperative anosmia and epistaxis while precluding the ability to raise pedicled nasoseptal flaps (NSF). We describe a bilateral “rescue flap” technique that preserves the mucosa containing the nasal-septal vascular pedicles and the SOS. This approach can reduce the risk of postoperative complications, including epistaxis and anosmia.

Methods

A retrospective analysis was conducted of all patients who underwent endoscopic transsphenoidal surgery with preservation of both sphenopalatine vascular pedicles and SOS. In a recent subset of patients, olfactory assessment was performed.

Results

Of 174 consecutive operations performed in 161 patients, bilateral preservation of the sphenopalatine vascular pedicle and SOS was achieved in 139 (80 %) operations, including 31 (22 %) with prior transsphenoidal surgery. Of the remaining 35 operations, 18 had a planned formal NSF and 17 had prior surgery or extensive lesions precluding use of this technique. Of pituitary adenomas, RCCs or sellar arachnoid cysts, 118 (94 %) underwent this approach, including 91 % of patients who had prior surgery. Preoperative olfaction function was maintained in 97 % of patients that were tested. None of the patients had postoperative arterial epistaxis.

Conclusion

Preservation of bilateral sphenopalatine vascular pedicles and the SOS is feasible in over 90 % of patients undergoing endonasal endoscopic surgery for pituitary adenomas and RCCs. This approach, while not hindering exposure or limiting instrument maneuverability, preserves the nasoseptal vasculature for future NSF use if needed and appears to minimize the risks of postoperative arterial epistaxis and anosmia.

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Acknowledgments

We would like to acknowledge support of this research from the following individuals: Carole Zumbro and George Adler Family; Carole and Jeff Schwartz; Ruth K. March and Family.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Saint Johns Medical Center, John Wayne Cancer Institute, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USA

    Chester F. Griffiths, Gal Bardo, Kian Karimi, Garni Barkhoudarian & Daniel F. Kelly

  2. University of Utah Medical Center, Salt Lake City, UT, USA

    Aaron R. Cutler

  3. Kaiser Permanente Health Center, Sacramento, CA, USA

    Huy T. Duong

  4. The Ohio State University Medical Center, Columbus, OH, USA

    Ricardo Carrau

Authors
  1. Chester F. Griffiths
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  2. Aaron R. Cutler
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  3. Huy T. Duong
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  4. Gal Bardo
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  5. Kian Karimi
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  6. Garni Barkhoudarian
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  7. Ricardo Carrau
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  8. Daniel F. Kelly
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Corresponding author

Correspondence to Garni Barkhoudarian.

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Comment

The authors have described a technique that they have utilized to preserve the sphenopalatine artery during endoscopic transnasal surgery, to be able to use it for nasoseptal flap development subsequently. They have utilized the approach on a large number of patients with success. I find that the risk of epistaxis in our own series is much lower than the percentage than they quote whether the SPA is violated or not. The bilateral incisions used here may be overkill for procedures in which a unilateral approach is chosen for tumor resection. However, the authors should be commended for bringing this interesting technique to our readership.

WT Coulwell

Utah, USA

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Griffiths, C.F., Cutler, A.R., Duong, H.T. et al. Avoidance of postoperative epistaxis and anosmia in endonasal endoscopic skull base surgery: a technical note. Acta Neurochir 156, 1393–1401 (2014). https://doi.org/10.1007/s00701-014-2107-8

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  • DOI: https://doi.org/10.1007/s00701-014-2107-8

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