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Olfactory outcomes after endonasal skull base surgery: a systematic review

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Abstract

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.

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References

  1. Rotenberg B, Tam S, Ryu WH, Duggal N (2010) Microscopic versus endoscopic pituitary surgery: a systematic review. Laryngoscope 120(7):1292–1297

    Article  PubMed  Google Scholar 

  2. Schwartz TH, Morgenstern PF, Anand VK (2019) Lessons learned in the evolution of endoscopic skull base surgery. J Neurosurg 130(2):337–346

    Article  PubMed  Google Scholar 

  3. Cavel O, Abergel A, Margalit N, Fliss DM, Gil Z (2012) Quality of life following endoscopic resection of skull base tumors. J Neurol Surg B Skull Base 73(2):112–116

    Article  PubMed  PubMed Central  Google Scholar 

  4. Little AS, Kelly DF, Milligan J, Griffiths C, Prevedello DM, Carrau RL, Rosseau G, Barkhoudarian G, Jahnke H, Chaloner C, Jelinek KL, Chapple K, White WL (2015) Comparison of sinonasal quality of life and health status in patients undergoing microscopic and endoscopic transsphenoidal surgery for pituitary lesions: a prospective cohort study. J Neurosurg 123(3):799–807

    Article  PubMed  Google Scholar 

  5. Pant H, Bhatki AM, Snyderman CH, Vescan AD, Carrau RL, Gardner P, Prevedello D, Kassam AB (2010) Quality of life following endonasal skull base surgery. Skull Base 20(1):35–40

    Article  PubMed  PubMed Central  Google Scholar 

  6. Greig SR, Cooper TJ, Sommer DD, Nair S, Wright ED (2016) Objective sinonasal functional outcomes in endoscopic anterior skull-base surgery: an evidence-based review with recommendations. Int Forum Allergy Rhinol 6(10):1040–1046

    Article  PubMed  Google Scholar 

  7. Koskinen K, Reichert JL, Hoier S, Schachenreiter J, Duller S, Moissl-Eichinger C, Schopf V (2018) The nasal microbiome mirrors and potentially shapes olfactory function. Sci Rep 8(1):1296

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Actor B, Sarnthein J, Prommel P, Holzmann D, Bernays RL (2010) Olfactory improvement in acromegaly after transnasal transsphenoidal surgery. Neurosurg Focus 29(4):E10

    Article  PubMed  Google Scholar 

  9. Alobid I, Ensenat J, Marino-Sanchez F, de Notaris M, Centellas S, Mullol J, Bernal-Sprekelsen M (2013) Impairment of olfaction and mucociliary clearance after expanded endonasal approach using vascularized septal flap reconstruction for skull base tumors. Neurosurgery 72(4):540–546

    Article  PubMed  Google Scholar 

  10. Awad AJ, Mohyeldin A, El-Sayed IH, Aghi MK (2015) Sinonasal morbidity following endoscopic endonasal skull base surgery. Clin Neurol Neurosurg 130:162–167

    Article  PubMed  Google Scholar 

  11. Browne JD, Mims JW (2000) Preservation of olfaction in anterior skull base surgery. Laryngoscope 110(8):1317–1322

    Article  CAS  PubMed  Google Scholar 

  12. Chaaban MR, Chaudhry AL, Riley KO, Woodworth BA (2015) Objective assessment of olfaction after transsphenoidal pituitary surgery. Am J Rhinol Allergy 29(5):365–368

    Article  PubMed  Google Scholar 

  13. Dolci RLL, Miyake MM, Tateno DA, Cancado NA, Campos CAC, Dos Santos ARL, Lazarini PR (2017) Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base. Rev Bras Otorrinolaringol 83(3):349–355

    Google Scholar 

  14. Geltzeiler MN, Wang EW (2018) Delayed complications from expanded endonasal surgery for intracranial tumors. Curr Opin Otolaryngol Head Neck Surg 26(1):65–70

    Article  PubMed  Google Scholar 

  15. Griffiths CF, Cutler AR, Duong HT, Bardo G, Karimi K, Barkhoudarian G, Carrau R, Kelly DF (2014) Avoidance of postoperative epistaxis and anosmia in endonasal endoscopic skull base surgery: a technical note. Acta Neurochir 156(7):1393–1401

    Article  PubMed  Google Scholar 

  16. Hanson M, Patel PM, Betz C, Olson S, Panizza B, Wallwork B (2015) Sinonasal outcomes following endoscopic anterior skull base surgery with nasoseptal flap reconstruction: a prospective study. J Laryngol Otol 129(Suppl 3):S41–S46

    Article  PubMed  Google Scholar 

  17. Hart CK, Theodosopoulos PV, Zimmer LA (2010) Olfactory changes after endoscopic pituitary tumor resection. Otolaryngol Head Neck Surg 142(1):95–97

    Article  PubMed  Google Scholar 

  18. Harvey RJ, Malek J, Winder M, Davidson A, Steel T, Mrad N, Barham H, Knisely A, Teo C (2015) Sinonasal morbidity following tumour resection with and without nasoseptal flap reconstruction. Rhinology 53(2):122–128

    PubMed  Google Scholar 

  19. Harvey RJ, Winder M, Davidson A, Steel T, Nalavenkata S, Mrad N, Bokhari A, Barham H, Knisely A (2015) The olfactory strip and its preservation in endoscopic pituitary surgery maintains smell and sinonasal function. J Neurol Surg Skull Base 76(6):464–470

    Article  Google Scholar 

  20. Hong SD, Nam DH, Kong DS, Kim HY, Chung SK, Dhong HJ (2016) Endoscopic modified transseptal transsphenoidal approach for maximal preservation of sinonasal quality of life and olfaction. World Neurosurg 87:162–169

    Article  PubMed  Google Scholar 

  21. Hong SD, Nam DH, Park J, Kim HY, Chung SK, Dhong HJ (2014) Olfactory outcomes after endoscopic pituitary surgery with nasoseptal “rescue” flaps: electrocautery versus cold knife. Am J Rhinol Allergy 28(6):517–519

    Article  PubMed  Google Scholar 

  22. Hong SD, Nam DH, Seol HJ, Choi NY, Kim HY, Chung SK, Dhong HJ (2015) Endoscopic binostril versus transnasal transseptal microscopic pituitary surgery: sinonasal quality of life and olfactory function. Am J Rhinol Allergy 29(3):221–225

    Article  PubMed  Google Scholar 

  23. Huo XH, Wang LT, Liang Y, Hou Q, Tian JH (2017) Analysis of olfactory dysfunction after endoscopic and microscopic endonasal transsphenoidal surgery for pituitary adenoma. Lin chuang er bi yan hou tou jing wai ke za zhi = J Clin Otorhinolaryngol Head Neck Surg 31(19):1512–1518

    CAS  Google Scholar 

  24. Ikeda K, Watanabe K, Suzuki H, Oshima T, Tanno N, Shimomura A, Sunose H, Takasaka T, Ikeda H, Yoshimoto T (1999) Nasal airway resistance and olfactory acuity following transsphenoidal pituitary surgery. Am J Rhinol 13(1):45–48

    Article  CAS  PubMed  Google Scholar 

  25. Jalessi M, Jahanbakhshi A, Amini E, Kamrava SK, Farhadi M (2016) Impact of nasoseptal flap elevation on sinonasal quality of life in endoscopic endonasal approach to pituitary adenomas. Eur Arch Otorhinolaryngol 273(5):1199–1205

    Article  PubMed  Google Scholar 

  26. Kahilogullari G, Beton S, Al-Beyati ES, Kantarcioglu O, Bozkurt M, Kantarcioglu E, Comert A, Unlu MA, Meco C (2013) Olfactory functions after transsphenoidal pituitary surgery: endoscopic versus microscopic approach. Laryngoscope 123(9):2112–2119

    Article  PubMed  Google Scholar 

  27. Kim BY, Kang SG, Kim SW, Hong YK, Jeun SS, Kim SW, Kim HB, Kim M, Maeng JH, Lee DC, Cho JH, Park YJ (2014) Olfactory changes after endoscopic endonasal transsphenoidal approach for skull base tumors. Laryngoscope 124(11):2470–2475

    Article  PubMed  Google Scholar 

  28. Kim DH, Hong YK, Jeun SS, Park JS, Kim SW, Cho JH, Park YJ, Jeong JW, Kim SW (2018) Can tumor size be a predictive factor of olfactory dysfunction after endoscopic endonasal trans-sphenoidal approach? J Craniofac Surg 29(3):543–546

    Article  PubMed  Google Scholar 

  29. Kim DH, Hong YK, Jeun SS, Park YJ, Kim SW, Cho JH, Kim BY, Han S, Lee YJ, Hwang JH, Kim SW (2016) Intranasal volume changes caused by the endoscopic endonasal transsphenoidal approach and their effects on nasal functions. PLoS One 11(3):e0151531

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. do Kim H, Hong YK, Jeun SS, Park YJ, Kim SW, Cho JH, Kim BY, Han S, Jung YH, Lee YJ et al (2016) Anatomic changes caused by endoscopic endonasal transsphenoidal surgery and their effects on nasal functions. Otolaryngol head Neck Surg 154(6):1132–1137

    Article  PubMed  Google Scholar 

  31. Kiraz M, Gunaldi O, Tanriverdi O, Erdim I, Postalci LS, Tugcu B, Yazici MZ (2018) Comparison of sinonasal complications of microscopic and endoscopic approaches for transsphenoidal hypophyseal surgery: prospective study. Turk Neurosurg 28(6):915–922

    PubMed  Google Scholar 

  32. Lavigne P, Faden DL, Wang EW, Snyderman CH (2018) Complications of nasoseptal flap reconstruction: a systematic review. J Neurol Surg Skull Base 79(Supplement(4)):S291–S299

    Article  Google Scholar 

  33. Little AS, Kelly D, Milligan J, Griffiths C, Prevedello DM, Carrau RL, Rosseau G, Barkhoudarian G, Otto BA, Jahnke H, Chaloner C, Jelinek KL, Chapple K, White WL (2015) Predictors of sinonasal quality of life and nasal morbidity after fully endoscopic transsphenoidal surgery. J Neurosurg 122(6):1458–1465

    Article  PubMed  Google Scholar 

  34. Majovsky M, Astl J, Kovar D, Masopust V, Benes V, Netuka D (2018) Olfactory function in patients after transsphenoidal surgery for pituitary adenomas-a short review. Neurosurg Rev

  35. Matano F, Murai Y, Mizunari T, Tateyama K, Kobayashi S, Adachi K, Kamiyama H, Morita A, Teramoto A (2016) Olfactory preservation during anterior interhemispheric approach for anterior skull base lesions: technical note. Neurosurg Rev 39(1):63–68 discussion 69

    Article  PubMed  Google Scholar 

  36. Nielsen EH, Lindholm J, Laurberg P, Bjerre P, Christiansen JS, Hagen C, Juul S, Jorgensen J, Kruse A, Stochholm K (2007) Nonfunctioning pituitary adenoma: incidence, causes of death and quality of life in relation to pituitary function. Pituitary 10(1):67–73

    Article  PubMed  Google Scholar 

  37. Patel ZM, DelGaudio JM (2016) Olfaction following endoscopic skull base surgery. Curr Opin Otolaryngol Head Neck Surg 24(1):70–74

    Article  PubMed  Google Scholar 

  38. Rioja E, Bernal-Sprekelsen M, Enriquez K, Ensenat J, Valero R, de Notaris M, Mullol J, Alobid I (2016) Long-term outcomes of endoscopic endonasal approach for skull base surgery: a prospective study. Eur Arch Otorhinolaryngol 273(7):1809–1817

    Article  PubMed  Google Scholar 

  39. Saito K, Takahashi M, Fukuta K, Tachibana E, Yoshida J (1999) Recovery of olfactory function after an anterior craniofacial approach. Skull Base Surg 9(3):201–206

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Sowerby LJ, Gross M, Broad R, Wright ED (2013) Olfactory and sinonasal outcomes in endoscopic transsphenoidal skull-base surgery. Int Forum Allergy Rhinol 3(3):217–220

    Article  PubMed  Google Scholar 

  41. Soyka MB, Serra C, Regli L, Meier E, Holzmann D (2017) Long-term olfactory outcome after nasoseptal flap reconstructions in midline skull base surgery. Am J Rhinol Allergy 31(5):334–337

    Article  PubMed  Google Scholar 

  42. Thompson CF, Kern RC, Conley DB (2015) Olfaction in endoscopic sinus and skull base surgery. Otolaryngol Clin N Am 48(5):795–804

    Article  Google Scholar 

  43. Upadhyay S, Buohliqah L, Dolci RLL, Otto BA, Prevedello DM, Carrau RL (2017) Periodic olfactory assessment in patients undergoing skull base surgery with preservation of the olfactory strip. Laryngoscope 127(9):1970–1975

    Article  PubMed  Google Scholar 

  44. Wang S, Chen Y, Li J, Wei L, Wang R (2015) Olfactory function and quality of life following microscopic endonasal transsphenoidal pituitary surgery. Medicine 94(4):e465

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kim DH, Hong YK, Jeun SS, Park JS, Lim DJ, Kim SW, Cho JH, Park YJ, Kim Y, Kim SW (2017) Endoscopic endonasal transsphenoidal approach from the surgeon point of view. J Craniofac Surg 28(4):959–962

    Article  PubMed  Google Scholar 

  46. Kim SW, Park KB, Khalmuratova R, Lee HK, Jeon SY, Kim DW (2013) Clinical and histologic studies of olfactory outcomes after nasoseptal flap harvesting. Laryngoscope 123(7):1602–1606

    Article  PubMed  Google Scholar 

  47. Rotenberg BW, Saunders S, Duggal N (2011) Olfactory outcomes after endoscopic transsphenoidal pituitary surgery. Laryngoscope 121(8):1611–1613

    Article  PubMed  Google Scholar 

  48. Tam S, Duggal N, Rotenberg BW (2013) Olfactory outcomes following endoscopic pituitary surgery with or without septal flap reconstruction: a randomized controlled trial. Int Forum Allergy Rhinol 3(1):62–65

    Article  PubMed  Google Scholar 

  49. Briner HR, Simmen D (1999) Smell diskettes as screening test of olfaction. Rhinology 37(4):145–148

    CAS  PubMed  Google Scholar 

  50. Fornazieri MA, Doty RL, Santos CA, Pinna Fde R, Bezerra TF, Voegels RL (2013) A new cultural adaptation of the University of Pennsylvania Smell Identification Test. Clinics (Sao Paulo) 68(1):65–68

    Article  Google Scholar 

  51. Doty RL, Marcus A, Lee WW (1996) Development of the 12-item Cross-Cultural Smell Identification Test (CC-SIT). Laryngoscope 106(3 Pt 1):353–356

    Article  CAS  PubMed  Google Scholar 

  52. Hummel T, Sekinger B, Wolf SR, Pauli E (1997) Kobal G: ‘Sniffin' sticks’: olfactory performance assessed by the combined testing of odor identification, odor discrimination and olfactory threshold. Chem Senses 22(1):39–52

    Article  CAS  PubMed  Google Scholar 

  53. Yang L, Wei Y, Yu D, Zhang J, Liu Y (2010) Olfactory and gustatory function in healthy adult Chinese subjects. Otolaryngol Head Neck Surg 143(4):554–560

    Article  PubMed  Google Scholar 

  54. Cardesin A, Alobid I, Benitez P, Sierra E, de Haro J, Bernal-Sprekelsen M, Picado C, Mullol J (2006) Barcelona Smell Test - 24 (BAST-24): validation and smell characteristics in the healthy Spanish population. Rhinology 44(1):83–89

    PubMed  Google Scholar 

  55. Cain WS, Gent JF, Goodspeed RB, Leonard G (1988) Evaluation of olfactory dysfunction in the Connecticut Chemosensory Clinical Research Center. Laryngoscope 98(1):83–88

    Article  CAS  PubMed  Google Scholar 

  56. Hummel T, Nordin S (2005) Olfactory disorders and their consequences for quality of life. Acta Otolaryngol 125(2):116–121

    Article  PubMed  Google Scholar 

  57. Escada PA, Lima C, da Silva JM: The human olfactory mucosa. Eur Arch Oto-rhino-laryngol 2009, 266(11):1675-1680.

  58. Holbrook EH, Wu E, Curry WT, Lin DT, Schwob JE (2011) Immunohistochemical characterization of human olfactory tissue. Laryngoscope 121(8):1687–1701

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Escada P (2013) Localization and distribution of human olfactory mucosa in the nasal cavities. Acta Medica Port 26(3):200–207

    Google Scholar 

  60. Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A (2006) A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116(10):1882–1886

    Article  PubMed  Google Scholar 

  61. Kassam AB, Thomas A, Carrau RL, Snyderman CH, Vescan A, Prevedello D, Mintz A, Gardner P (2008) Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 63(1 Suppl 1):ONS44–ONS52 discussion ONS52-43

    PubMed  Google Scholar 

  62. Rivera-Serrano CM, Snyderman CH, Gardner P, Prevedello D, Wheless S, Kassam AB, Carrau RL, Germanwala A, Zanation A (2011) Nasoseptal “rescue” flap: a novel modification of the nasoseptal flap technique for pituitary surgery. Laryngoscope 121(5):990–993

    Article  PubMed  Google Scholar 

  63. Leopold DA, Hummel T, Schwob JE, Hong SC, Knecht M, Kobal G (2000) Anterior distribution of human olfactory epithelium. Laryngoscope 110(3 Pt 1):417–421

    Article  CAS  PubMed  Google Scholar 

  64. Nyquist GG, Anand VK, Brown S, Singh A, Tabaee A, Schwartz TH (2010) Middle turbinate preservation in endoscopic transsphenoidal surgery of the anterior skull base. Skull Base 20(5):343–347

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

We acknowledge the library of Jinling Hospital for providing instructions of searching literature.

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  1. Junhao Zhu and Kaiyang Feng contributed equally to this work.

Authors and Affiliations

  1. Jinling Hospital, School of Medicine, Nanjing Medical University, 104 Hanzhong Road, Nanjing, 210002, China

    Junhao Zhu, Jin Yang, Chunyu Zhong & Chiyuan Ma

  2. Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China

    Junhao Zhu, Chao Tang, Jin Yang, Chunyu Zhong & Chiyuan Ma

  3. Arkansas College of Health Education, 7000 Chad Colley Blvd, Fort Smith, AR, 72916, USA

    Kaiyang Feng

  4. School of Medicine, Southeast University, Nanjing, 210009, China

    Xiangming Cai

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  1. Junhao Zhu
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Zhu, J., Feng, K., Tang, C. et al. Olfactory outcomes after endonasal skull base surgery: a systematic review. Neurosurg Rev 44, 1805–1814 (2021). https://doi.org/10.1007/s10143-020-01385-1

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