Better nasal recovery and intact olfactory function after transseptal
approach for endoscopic endonasal transphenoidal adenomectomy: a
Objectives Endoscopic endonasal transsphenoidal adenomectomy (TSA) is
the most frequently performed skull base surgery and researchers have
recently focused on preserving nasal function. The transseptal approach
is a promising procedure owing to its less injury to nasal mucosa.
Therefore, we conducted this study to investigate whether the
transseptal approach could reduce nasal morbidities with comparable
neurosurgical outcomes. Study design Retrospective chart review. Setting
Single-institution tertiary care centre. Participants 25 patients of
transseptal approach from January 2019 to December 2020 and 25 patients
of transnasal approach from January 2017 to December 2018. Main outcome
measures Lund-Kennedy endoscopic scores, 22-item sinonasal outcome test
(SNOT-22) scores, TIB smell identification tests (TIBSIT®) scores, the
rate of gross total resection, endocrine control, and postoperative
complications were collected. Results The postoperative SNOT-22 (4.40
vs. 7.36, P =.005) and Lund-Kennedy endoscopic scores (2.72 vs, 5.08 at
2 weeks, 0.88 vs. 3.52 at 1 month, 0.48 vs. 2.12 at 3 months, 0.04 vs.
1.76 at 6 months, all adjusted P < .01) were significantly
lower in the transseptal group, while the TIBSIT scores were not
significantly different (41.6 vs. 42.4 preoperatively, P = .68; 41.6 vs.
40.2 postoperatively, P = .46). The rates of gross total resection,
recovery of hormonal abnormalities, and complications were not
significantly different. In multivariate analysis, the transseptal
approach remained an independent factor for lower SNOT-22 scores and
Lund-Kennedy endoscopic scores. Conclusion The transseptal approach
provides better recovery of nasal mucosa and intact olfactory function
without compromising neurosurgical outcomes.