Preservation of nasal septal cartilage in endoscopic transsphenoidal approach surgery

IF 0.4 Q4 CLINICAL NEUROLOGY
Taishi Nakamura , Yamato Oki , Kenta Fukui , Katsumi Sakata , Hiromitsu Hatakeyama , Tetsuya Yamamoto , Nobuhiko Oridate
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Abstract

Background

The transseptal approach is widely used in a range of cases in endoscopic transsphenoidal neurosurgery. However, dissecting the mucosa from the septum can lead to perforation in some cases, and the resultant postoperative mucosal perforation can cause symptoms of discomfort, such as recurrent epistaxis, nasal crusting, headache, and nasal obstruction. In this study, we analyzed a technique for preserving the nasal septal cartilage to reduce nasal septal mucosal perforation in terms of the size and frequency of the perforations as well as the symptoms caused by them. We also evaluated the technical complexity of this technique and its potential to cause obstruction of vision and manipulation.

Materials and methods

We enrolled a consecutive series of patients who underwent endoscopic transsphenoidal surgery using the nasal septal cartilage-preserving technique. Intraoperative and postoperative mucosal perforations of the nasal septum were confirmed.

Results

Eighteen patients underwent surgery using this technique. Surgery was previously performed in only one patient with a pituitary neuroendocrine tumor. Among the other 17 patients who underwent primary surgery, seven showed intraoperative perforation of some size during detachment of the nasal septal mucosa from the nasal septum. Three cases, including a reoperation case, showed nasal septal perforation on outpatient examination a few months later, and no symptoms were associated with postoperative perforation in these three patients.

Conclusion

Preserving the septal cartilage prevents perforation of the anterior component of the nasal septum and contributes to reducing the risk of postoperative perforation and its symptomatic occurrence without obstructing intraoperative manipulation.
内镜下经蝶窦入路手术中鼻中隔软骨的保存
背景:经鼻中隔入路在内镜下经蝶窦神经外科手术中广泛应用。然而,在某些情况下,从鼻中隔剥离粘膜可导致穿孔,术后粘膜穿孔可引起不适症状,如复发性鼻出血、鼻结痂、头痛和鼻塞。在这项研究中,我们分析了一种保留鼻中隔软骨的技术,以减少鼻中隔粘膜穿孔的大小和频率,以及由此引起的症状。我们还评估了该技术的技术复杂性及其造成视觉和操作障碍的可能性。材料和方法我们招募了一系列连续的患者,他们接受了内镜下经蝶窦手术,采用鼻中隔软骨保留技术。术中及术后确认鼻中隔粘膜穿孔。结果18例患者采用该技术行手术治疗。手术以前只在一例垂体神经内分泌肿瘤患者中进行。在其他17例接受初次手术的患者中,7例在鼻中隔粘膜脱离鼻中隔时出现一定大小的术中穿孔。3例患者,包括1例再次手术患者,几个月后门诊检查显示鼻中隔穿孔,3例患者均无术后穿孔相关症状。结论保留鼻中隔软骨可防止鼻中隔前段穿孔,在不妨碍术中操作的情况下,有助于降低术后穿孔及其症状发生的风险。
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来源期刊
CiteScore
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0.00%
发文量
236
审稿时长
15 weeks
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