Skip to main content
SpringerLink
Log in

Rhinological Complications: Avoidance and Management

  • Chapter
  • First Online:
Transsphenoidal Surgery

  • 1571 Accesses

Abstract

The endoscopic transsphenoidal approach is becoming the technique of choice for accessing sellar, parasellar, and anterior skull base pathologies. This expanding role of endonasal skull base surgery is the result of concerted effort to prevent and manage peri- and postoperative complications. Although complications may be inherent in any surgical procedure, they are best prevented rather than treated.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Snyderman C, Kassam A, Carrau R, Mintz A, Gardner P, Prevedello DM. Acquisition of surgical skills for endonasal skull base surgery: a training program. Laryngoscope. 2007;117(4):699–705. doi:10.1097/MLG.0b013e318031c817.

    Article  PubMed  Google Scholar 

  2. Schaberg MR, Anand VK, Schwartz TH. 10 pearls for safe endoscopic skull base surgery. Otolaryngol Clin N Am. 2010;43(4):945–54. doi:10.1016/j.otc.2010.04.022.

    Article  Google Scholar 

  3. Nyquist GG, Rosen MR, Friedel ME, Beahm DD, Farrell CJ, Evans JJ. Comprehensive management of the paranasal sinuses in patients undergoing endoscopic endonasal skull base surgery. World Neurosurg. 2014;82(6 Suppl):S54–8. doi:10.1016/j.wneu.2014.07.027.

    Article  PubMed  Google Scholar 

  4. Griffiths CF, Cutler AR, Duong HT, Bardo G, Karimi K, Barkhoudarian G, Carrau R, Kelly DF. Avoidance of postoperative epistaxis and anosmia in endonasal endoscopic skull base surgery: a technical note. Acta Neurochir. 2014;156(7):1393–401. doi:10.1007/s00701-014-2107-8.

    Article  PubMed  Google Scholar 

  5. Rivera-Serrano CM, Snyderman CH, Gardner P, Prevedello D, Wheless S, Kassam AB, Carrau RL, Germanwala A, Zanation A. Nasoseptal “rescue” flap: a novel modification of the nasoseptal flap technique for pituitary surgery. Laryngoscope. 2011;121(5):990–3. doi:10.1002/lary.21419.

    Article  PubMed  Google Scholar 

  6. Kassam A, Snyderman CH, Carrau RL, Gardner P, Mintz A. Endoneurosurgical hemostasis techniques: lessons learned from 400 cases. Neurosurg Focus. 2005;19(1):E7.

    PubMed  Google Scholar 

  7. Singh A, Schaberg M, Nyquist G, Anand V. Post-operative sinonasal management. In: Endoscopic pituitary surgery. New York/Stuttgart: Thieme; 2011.

    Google Scholar 

  8. Hendricks BL, Shikary TA, Zimmer LA. Causes for 30-day readmission following transsphenoidal surgery. Otolaryngol Head Neck Surg Off J Am Acad Otolaryngol Head Neck Surg. 2015; doi:10.1177/0194599815617130.

    Article  Google Scholar 

  9. Placantonakis DG, Tabaee A, Anand VK, Hiltzik D, Schwartz TH. Safety of low-dose intrathecal fluorescein in endoscopic cranial base surgery. Neurosurgery. 2007;61(3 Suppl):161–5; discussion 165–166. doi:10.1227/01.neu.0000289729.20083.dc

  10. Tabaee A, Placantonakis DG, Schwartz TH, Anand VK. Intrathecal fluorescein in endoscopic skull base surgery. Otolaryngol Head Neck Surg Off J Am Acad Otolaryngol Head Neck Surg. 2007;137(2):316–20. doi:10.1016/j.otohns.2006.11.012.

    Article  Google Scholar 

  11. Tabaee A, Anand VK, Brown SM, Lin JW, Schwartz TH. Algorithm for reconstruction after endoscopic pituitary and skull base surgery. Laryngoscope. 2007;117(7):1133–7. doi:10.1097/MLG.0b013e31805c08c5.

    Article  PubMed  Google Scholar 

  12. Kassam AB, Prevedello DM, Carrau RL, Snyderman CH, Thomas A, Gardner P, Zanation A, Duz B, Stefko ST, Byers K, Horowitz MB. Endoscopic endonasal skull base surgery: analysis of complications in the authors' initial 800 patients. J Neurosurg. 2011;114(6):1544–68. doi:10.3171/2010.10.JNS09406.

    Article  PubMed  Google Scholar 

  13. Patel MR, Stadler ME, Snyderman CH, Carrau RL, Kassam AB, Germanwala AV, Gardner P, Zanation AM. How to choose? Endoscopic skull base reconstructive options and limitations. Skull Base Off J North Am Skull Base Soc [et al]. 2010;20(6):397–404. doi:10.1055/s-0030-1253573.

  14. Esposito F, Dusick JR, Fatemi N, Kelly DF. Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Neurosurgery. 2007;60(4 Suppl 2):295–303; discussion 303–294. doi:10.1227/01.NEU.0000255354.64077.66

  15. Harvey RJ, Smith JE, Wise SK, Patel SJ, Frankel BM, Schlosser RJ. Intracranial complications before and after endoscopic skull base reconstruction. Am J Rhinol. 2008;22(5):516–21. doi:10.2500/ajr.2008.22.3223.

    Article  PubMed  Google Scholar 

  16. Kida Y. Gentamicin and CFTR. N Engl J Med. 2003;349(26):2570. doi:10.1056/NEJM200312253492622.

    Article  CAS  PubMed  Google Scholar 

  17. de Almeida JR, Snyderman CH, Gardner PA, Carrau RL, Vescan AD. Nasal morbidity following endoscopic skull base surgery: a prospective cohort study. Head Neck. 2011;33(4):547–51. doi:10.1002/hed.21483.

    Article  PubMed  Google Scholar 

  18. Bugten V, Nordgard S, Steinsvag S. The effects of debridement after endoscopic sinus surgery. Laryngoscope. 2006;116(11):2037–43. doi:10.1097/01.mlg.0000241362.06072.83.

    Article  PubMed  Google Scholar 

  19. Schaberg MR, Shah GB, Evans JJ, Rosen MR. Concomitant transsphenoidal approach to the anterior skull base and endoscopic sinus surgery in patients with chronic rhinosinusitis. J Neurol Surg B Skull Base. 2013;74(4):241–6. doi:10.1055/s-0033-1342916.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Nyquist GG, Friedel ME, Singhal S, Beahm DD, Farrell CJ, Evans JJ, Rosen MR. Surgical management of rhinosinusitis in endoscopic-endonasal skull-base surgery. Int Forum Allergy Rhinol. 2015;5(4):339–43. doi:10.1002/alr.21476.

    Article  PubMed  Google Scholar 

  21. Kuhn FA, Citardi MJ. Advances in postoperative care following functional endoscopic sinus surgery. Otolaryngol Clin N Am. 1997;30(3):479–90.

    Article  CAS  Google Scholar 

  22. Vaezeafshar R, Hwang PH, Harsh G, Turner JH. Mucocele formation under pedicled nasoseptal flap. Am J Otolaryngol. 2012;33(5):634–6. doi:10.1016/j.amjoto.2012.05.003.

    Article  PubMed  Google Scholar 

  23. Bleier BS, Wang EW, Vandergrift 3rd WA, Schlosser RJ. Mucocele rate after endoscopic skull base reconstruction using vascularized pedicled flaps. Am J Rhinol Allergy. 2011;25(3):186–7. doi:10.2500/ajra.2011.25.3587.

    Article  PubMed  Google Scholar 

  24. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MD. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg Off J Am Acad Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1–S39. doi:10.1177/0194599815572097.

    Article  Google Scholar 

  25. Brown SM, Anand VK, Tabaee A, Schwartz TH. Role of perioperative antibiotics in endoscopic skull base surgery. Laryngoscope. 2007;117(9):1528–32. doi:10.1097/MLG.0b013e3180caa177.

    Article  CAS  PubMed  Google Scholar 

  26. Naunheim MR, Sedaghat AR, Lin DT, Bleier BS, Holbrook EH, Curry WT, Gray ST. Immediate and delayed complications following endoscopic skull base surgery. J Neurol Surg B Skull Base. 2015;76(5):390–6. doi:10.1055/s-0035-1549308.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 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. Predictors of sinonasal quality of life and nasal morbidity after fully endoscopic transsphenoidal surgery. J Neurosurg. 2015;122(6):1458–65. doi:10.3171/2014.10.JNS141624.

    Article  PubMed  Google Scholar 

  28. Marcolini TR, Safraider MC, Socher JA, Lucena GO. Differential diagnosis and treatment of isolated pathologies of the sphenoid sinus: retrospective study of 46 cases. Int Archiv Otorhinolaryngol. 2015;19(2):124–9. doi:10.1055/s-0034-1397337.

    Article  Google Scholar 

  29. Senior BA, Ebert CS, Bednarski KK, Bassim MK, Younes M, Sigounas D, Ewend MG. Minimally invasive pituitary surgery. Laryngoscope. 2008;118(10):1842–55. doi:10.1097/MLG.0b013e31817e2c43.

    Article  PubMed  Google Scholar 

  30. Lu YJ, Chang CN, Pai PC, Wei KC, Chuang CC. Isolated sphenoid sinusitis or mucocele: a potential complication of endonasal transsphenoidal surgery. J Neuro-Oncol. 2009;91(1):63–7. doi:10.1007/s11060-008-9681-7.

    Article  Google Scholar 

  31. Batra PS, Citardi MJ, Lanza DC. Isolated sphenoid sinusitis after transsphenoidal hypophysectomy. Am J Rhinol. 2005;19(2):185–9.

    Article  Google Scholar 

  32. Leopold DA, Hummel T, Schwob JE, Hong SC, Knecht M, Kobal G. Anterior distribution of human olfactory epithelium. Laryngoscope. 2000;110(3 Pt 1):417–21. doi:10.1097/00005537-200003000-00016.

    Article  CAS  PubMed  Google Scholar 

  33. Escada PA, Lima C, da Silva JM. The human olfactory mucosa. Eur Archiv Otorhinolaryngol Off J Eur Fed Oto-Rhino-Laryngological Soc. 2009;266(11):1675–80. doi:10.1007/s00405-009-1073-x.

    Article  Google Scholar 

  34. Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope. 2006;116(10):1882–6. doi:10.1097/01.mlg.0000234933.37779.e4.

    Article  PubMed  Google Scholar 

  35. Harvey RJ, Winder M, Davidson A, Steel T, Nalavenkata S, Mrad N, Bokhari A, Barham H, Knisely A. The olfactory strip and its preservation in endoscopic pituitary surgery maintains smell and sinonasal function. J Neurol Surg B Skull Base. 2015;76(6):464–70. doi:10.1055/s-0035-1554905.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Zimmer LA, Shah O, Theodosopoulos PV. Short-term quality-of-life changes after endoscopic pituitary surgery rated with SNOT-22. J Neurol Surg B Skull Base. 2014;75(4):288–92. doi:10.1055/s-0034-1372464.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kim SW, Park KB, Khalmuratova R, Lee HK, Jeon SY, Kim DW. Clinical and histologic studies of olfactory outcomes after nasoseptal flap harvesting. Laryngoscope. 2013;123(7):1602–6. doi:10.1002/lary.24107.

    Article  PubMed  Google Scholar 

  38. Bedrosian JC, McCoul ED, Raithatha R, Akselrod OA, Anand VK, Schwartz TH. A prospective study of postoperative symptoms in sinonasal quality-of-life following endoscopic skull-base surgery: dissociations based on specific symptoms. Int Forum Allergy Rhinol. 2013;3(8):664–9. doi:10.1002/alr.21161.

    Article  PubMed  Google Scholar 

  39. Tam S, Duggal N, Rotenberg BW. Olfactory outcomes following endoscopic pituitary surgery with or without septal flap reconstruction: a randomized controlled trial. Int Forum Allergy Rhinol. 2013;3(1):62–5. doi:10.1002/alr.21069.

    Article  PubMed  Google Scholar 

  40. Georgalas C, Badloe R, van Furth W, Reinartz S, Fokkens WJ. Quality of life in extended endonasal approaches for skull base tumours. Rhinology. 2012;50(3):255–61. doi:10.4193/Rhino12.050.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Rhinology and Endoscopic Skull Base Surgery Otolaryngology-Head and Neck Surgery, University of Puerto Rico, School of Medicine, New York, NY, USA

    Gustavo J. Almodovar-Mercador MD (Assistant Professor)

  2. Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA

    Theodore H. Schwartz MD

  3. Department of Otolaryngology and Head and Neck Surgery, Weill Cornell Medical College, The New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA

    Vijay K. Anand MD

Authors
  1. Gustavo J. Almodovar-Mercador MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Theodore H. Schwartz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vijay K. Anand MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vijay K. Anand MD .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Harvard Medical School Brigham and Women’s Hospital, Boston, MA, USA

    Edward R. Laws, Jr

  2. Department of Neurosurgery, Indianapolis Methodist Hospital, Indianapolis, IN, USA

    Aaron A. Cohen-Gadol

  3. Department of Neurosurgery, Weill Cornell Medical College New York Presbyterian Hospital, New York, NY, USA

    Theodore H. Schwartz

  4. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA

    Jason P. Sheehan

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Almodovar-Mercador, G.J., Schwartz, T.H., Anand, V.K. (2017). Rhinological Complications: Avoidance and Management. In: Laws, Jr, E.R., Cohen-Gadol, A.A., Schwartz, T.H., Sheehan, J.P. (eds) Transsphenoidal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-56691-7_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-56691-7_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-56689-4

  • Online ISBN: 978-3-319-56691-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation