For the last two decades, endonasal approach has been regularly applied to treat skull base lesions. However, postoperative olfactory dysfunction remains an unsolved problem. This systematic review aimed to identify factors that might affect postoperative olfactory prognosis of patients undergoing endonasal surgery for resection of sellar/parasellar lesions. The literature search was conducted comprehensively to exhaust studies which focused on patients’ olfaction with objective olfactory assessments after endonasal skull base surgery. We sought to characterize the potential factors that might affect postoperative olfactory outcomes. Nineteen articles met inclusion criteria. We found that (1) endoscopic surgery was beneficial to patients’ olfactory prognosis than microscopic surgery (incidence of postoperative decreased olfactory function: 18.48% (39/211) for the endoscopic group and 36.88% (52/141) for the microscopic group, P < 0.01); meta-analysis for single rate, 20% (95% CI 9–30%) for the endoscopic group and 35% (95% CI 0–72%) for the microscopic group); (2) harvesting septal flaps was an unfavorable factor for olfactory recovery and the rescue flap technique should be preferred compared with the HB flap; (3) no evidence showed that resection of the middle turbinate was detrimental to recovery of olfaction. Patients undergoing endoscopic endonasal surgery may have better olfactory outcomes than those undergoing microscopic endonasal surgery for resection of sellar/parasellar lesions. Special attention should be paid when using septal flaps is planned and the rescue flap technique should be the preferred choice. After resecting the middle turbinate, patients’ olfaction still has a great chance of returning to the baseline. More homogeneous and high-quality studies are needed for further assessment.

在过去的二十年中，鼻内入路已被定期应用于治疗颅底病变。然而，术后嗅觉功能障碍仍然是一个未解决的问题。本系统评价旨在确定可能影响接受鼻内手术切除鞍/鞍旁病变的患者术后嗅觉预后的因素。对文献进行了全面检索，以穷尽研究，这些研究侧重于鼻内颅底手术后患者的嗅觉和客观嗅觉评估。我们试图描述可能影响术后嗅觉结果的潜在因素。19 篇文章符合纳入标准。我们发现（1）内镜手术比显微手术有利于患者的嗅觉预后（术后嗅觉功能下降发生率：18.磷< 0.01); 单一比率的荟萃分析，内窥镜组为 20%（95% CI 9-30%），显微镜组为 35%（95% CI 0-72%））；(2)取下鼻中隔皮瓣是嗅觉恢复的不利因素，与HB皮瓣相比应首选挽救皮瓣技术；(3) 没有证据表明切除中鼻甲不利于嗅觉的恢复。接受内窥镜鼻内手术的患者可能比接受镜下鼻内手术切除鞍区/鞍旁病变的患者有更好的嗅觉结果。计划使用间隔皮瓣时应特别注意，应首选抢救皮瓣技术。切除中鼻甲后，患者的嗅觉仍有很大机会恢复到基线水平。