Evaluation of Empty Nose Syndrome Scores in Patients Undergoing Extended Endoscopic Transnasal Sellar Surgery

Y. Kuo, Chia-Jung Lee, Hsing-Mei Wu, Chung-Yu Hao, Yung Liu, Y. Tsai
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Abstract

Background: Several large series have established endoscopic transnasal sellar surgery as the procedure of choice for removal of tumors in the sellar area. Although this procedure provides a less invasive approach to the sella, it entails complications such as nasal bleeding, impaired olfactory function, atrophic rhinitis, synechiae, etc. No studies have yet reported potential morbidities such as empty nose syndrome (ENS), although patients have a relatively empty nasal cavity after surgery. Therefore, we sought to verify the percentage of patients who truly met the diagnostic criteria for ENS after endoscopic transnasal sellar surgery, determine the variation between pre- and postoperative scores in each Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) item, and further evaluate the symptoms that may affect the patients the most after surgery. Methods: Between March 2015 and January 2019, eventually 11 patients who underwent extended endoscopic transnasal sellar surgery in Shin Kong Wu Ho-Su Memorial Hospital, a tertiary referral medical center in Taipei, Taiwan, were enrolled. The patients completed the recently validated ENS6Q after surgery. Results: One patient met the objective diagnostic criteria for ENS (score ≥ 11 in ENS6Q). Significant differences were observed in the pre- and postoperative total ENS6Q scores. The pre- and postoperative scores of “nose feeling too open” and nasal crusting showed statistically significant differences. Further, compared with the other items, the postoperative score of nasal crusting increased most obviously, and it may be the most apparent operation-related symptom. Conclusion: This study is the first to report the possibility of developing ENS after endoscopic transnasal sellar surgery. Although the transnasal endoscopic approach is a safe and minimally invasive procedure for the treatment of sellar lesions, possible complications such as ENS should be considered.
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内镜下经鼻鞍手术患者空鼻综合征评分的评价
背景:几个大型系列已经建立了经鼻内镜鞍区手术作为切除鞍区肿瘤的选择。虽然这种方法对鞍的侵入性较小,但它会引起鼻出血、嗅觉功能受损、萎缩性鼻炎、粘连等并发症。虽然患者术后鼻腔相对空,但目前还没有研究报告潜在的并发症,如空鼻综合征(ENS)。因此,我们试图验证内镜经鼻鞍手术后真正符合ENS诊断标准的患者百分比,确定空鼻综合征6项问卷(ENS6Q)各条目的术前和术后评分差异,并进一步评估术后可能对患者影响最大的症状。方法:在2015年3月至2019年1月期间,在台湾台北的三级转诊医疗中心新光吴浩苏纪念医院接受了经鼻鼻内镜手术的11例患者。患者在手术后完成了最近验证的ENS6Q。结果:1例患者符合ENS客观诊断标准(ENS6Q评分≥11分)。术前和术后总ENS6Q评分有显著差异。术前、术后“鼻感过开”和鼻结皮评分差异有统计学意义。此外,与其他项目相比,术后鼻结皮评分升高最明显,可能是最明显的手术相关症状。结论:本研究首次报道了内镜经鼻鞍手术后发生ENS的可能性。虽然经鼻内窥镜入路是治疗鞍区病变的一种安全且微创的方法,但应考虑可能的并发症,如ENS。
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