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Incidental sinonasal findings identified during preoperative evaluation for endoscopic transsphenoidal approaches.

Laury AM, Oyesiku NM, Hadjipanayis CG, Delgaudio JM, Wise SK - Am J Rhinol Allergy (2013 May-Jun)

Bottom Line: Occasionally, the approach is significantly altered by sinonasal disease, anatomic variants, or previous surgery.This is one of the larger reviews of patients undergoing eTSA for sellar lesions and the only study that describes how intraoperative management may be altered by preoperative sinonasal evaluation.We found a significant incidence of sinonasal pathology and anatomic variants that altered routine operative planning; therefore, a thorough sinonasal evaluation is warranted in these cases.

View Article: PubMed Central - PubMed

Affiliation: Emory University Sinus Nasal and Allergy Center, Atlanta, Georgia 30308, USA.

ABSTRACT

Background: The endoscopic transsphenoidal approach (eTSA) to lesions of the sellar region is typically performed jointly by neurosurgeons and otolaryngologists. Occasionally, the approach is significantly altered by sinonasal disease, anatomic variants, or previous surgery. However, there are no current guidelines that describe which physical or radiological findings should prompt a change in the plan of care. The purpose of this study was to determine the incidence of sinonasal pathology or anatomic variants noted endoscopically or by imaging that altered preoperative or intraoperative management.

Methods: A retrospective review was performed of 355 consecutive patients who underwent combined neurosurgery-otolaryngology endoscopic sella approach from August 1, 2007 to April 1, 2011. Our practice in these patients involves preoperative otolaryngology clinical evaluation and MRI review. Intraoperative image guidance is not routinely used in uncomplicated eTSA.

Results: The most common management alteration was the addition of image guidance based on anatomic variants on MRI, which occurred in 81 patients (35.0%). Eight patients (2.9%) were preoperatively treated with antibiotics and surgery was postponed secondary to acute or chronic purulent rhinosinusitis; two (0.7%) required functional endoscopic sinus surgery for medically refractory disease before eTSA. Five patients (1.8%) required anterior septoplasty intraoperatively for severe nasal septal deviation. Two patients (0.7%) had inverted papilloma and one patient had esthesioneuroblastoma identified preoperatively during rigid nasal endoscopy.

Conclusion: This is one of the larger reviews of patients undergoing eTSA for sellar lesions and the only study that describes how intraoperative management may be altered by preoperative sinonasal evaluation. We found a significant incidence of sinonasal pathology and anatomic variants that altered routine operative planning; therefore, a thorough sinonasal evaluation is warranted in these cases.

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Related in: MedlinePlus

Pie chart depicting the various MRI findings that prompted the acquisition and use of intraoperative image guidance for the endoscopic transsphenoidal approach (eTSA) to the sella.
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Figure 1: Pie chart depicting the various MRI findings that prompted the acquisition and use of intraoperative image guidance for the endoscopic transsphenoidal approach (eTSA) to the sella.

Mentions: Furthermore, each patient in this series underwent an MRI or CT scan (if they could not undergo MRI) as part of their neurosurgical workup before evaluation in the otolaryngology office. The MRI/CT and history and physical findings were reviewed to determine if image guidance was required during surgery. Overall, 81 (35.0%) patients had findings that changed routine eTSA by prompting the decision to use image guidance for the endoscopic transsphenoidal approach. The use of image guidance for the endoscopic transsphenoidal approach was the most common alteration in routine eTSA management based on sinonasal findings in this study. Figure 1 categorizes the findings on MRI that leads to the use of intraoperative image guidance for the eTSA. Of note, several patients had multiple criteria on imaging that compelled the use of image guidance. Figure 2 shows a preoperative MRI with common findings prompting the use of image guidance—tumor encroachment into the sphenoid sinus, as well as significant extrasellar and cavernous sinus involvement of tumor.


Incidental sinonasal findings identified during preoperative evaluation for endoscopic transsphenoidal approaches.

Laury AM, Oyesiku NM, Hadjipanayis CG, Delgaudio JM, Wise SK - Am J Rhinol Allergy (2013 May-Jun)

Pie chart depicting the various MRI findings that prompted the acquisition and use of intraoperative image guidance for the endoscopic transsphenoidal approach (eTSA) to the sella.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3649855&req=5

Figure 1: Pie chart depicting the various MRI findings that prompted the acquisition and use of intraoperative image guidance for the endoscopic transsphenoidal approach (eTSA) to the sella.
Mentions: Furthermore, each patient in this series underwent an MRI or CT scan (if they could not undergo MRI) as part of their neurosurgical workup before evaluation in the otolaryngology office. The MRI/CT and history and physical findings were reviewed to determine if image guidance was required during surgery. Overall, 81 (35.0%) patients had findings that changed routine eTSA by prompting the decision to use image guidance for the endoscopic transsphenoidal approach. The use of image guidance for the endoscopic transsphenoidal approach was the most common alteration in routine eTSA management based on sinonasal findings in this study. Figure 1 categorizes the findings on MRI that leads to the use of intraoperative image guidance for the eTSA. Of note, several patients had multiple criteria on imaging that compelled the use of image guidance. Figure 2 shows a preoperative MRI with common findings prompting the use of image guidance—tumor encroachment into the sphenoid sinus, as well as significant extrasellar and cavernous sinus involvement of tumor.

Bottom Line: Occasionally, the approach is significantly altered by sinonasal disease, anatomic variants, or previous surgery.This is one of the larger reviews of patients undergoing eTSA for sellar lesions and the only study that describes how intraoperative management may be altered by preoperative sinonasal evaluation.We found a significant incidence of sinonasal pathology and anatomic variants that altered routine operative planning; therefore, a thorough sinonasal evaluation is warranted in these cases.

View Article: PubMed Central - PubMed

Affiliation: Emory University Sinus Nasal and Allergy Center, Atlanta, Georgia 30308, USA.

ABSTRACT

Background: The endoscopic transsphenoidal approach (eTSA) to lesions of the sellar region is typically performed jointly by neurosurgeons and otolaryngologists. Occasionally, the approach is significantly altered by sinonasal disease, anatomic variants, or previous surgery. However, there are no current guidelines that describe which physical or radiological findings should prompt a change in the plan of care. The purpose of this study was to determine the incidence of sinonasal pathology or anatomic variants noted endoscopically or by imaging that altered preoperative or intraoperative management.

Methods: A retrospective review was performed of 355 consecutive patients who underwent combined neurosurgery-otolaryngology endoscopic sella approach from August 1, 2007 to April 1, 2011. Our practice in these patients involves preoperative otolaryngology clinical evaluation and MRI review. Intraoperative image guidance is not routinely used in uncomplicated eTSA.

Results: The most common management alteration was the addition of image guidance based on anatomic variants on MRI, which occurred in 81 patients (35.0%). Eight patients (2.9%) were preoperatively treated with antibiotics and surgery was postponed secondary to acute or chronic purulent rhinosinusitis; two (0.7%) required functional endoscopic sinus surgery for medically refractory disease before eTSA. Five patients (1.8%) required anterior septoplasty intraoperatively for severe nasal septal deviation. Two patients (0.7%) had inverted papilloma and one patient had esthesioneuroblastoma identified preoperatively during rigid nasal endoscopy.

Conclusion: This is one of the larger reviews of patients undergoing eTSA for sellar lesions and the only study that describes how intraoperative management may be altered by preoperative sinonasal evaluation. We found a significant incidence of sinonasal pathology and anatomic variants that altered routine operative planning; therefore, a thorough sinonasal evaluation is warranted in these cases.

Show MeSH
Related in: MedlinePlus