Comparative evaluation of olfactive performance of patients undergoing endoscopic skull base surgery with a nasoseptal or rescue flap

Abstract

Currently, the gold standard for pituitary gland or anterior skull base tumor removal is the endoscopic transnasal approach. There is however a problem: with the region most manipulated by the surgery being the nasal cavity, and because the latter hosts the olfactory neuroepithelium responsible for our sense of smell, there is a risk of olfactory function alterations. When loss of function occurs, it is often overlooked, even though it has the potential to cause a great impact on a patient's quality of life. One technical aspect of transnasal endoscopic surgery not often compared is the relation between the type of flap used and how that relates to olfactory postoperative function. The flap is a piece of tissue used to separate the central nervous system from the nasal cavity, with two types being the most prevalent ones: the nasoseptal flap, developed by Haddad and collaborators around 2006, and the rescue flap, developed by Rivera-Serrano and collaborators around 2011. We believe that when compared, patients in which the rescue flap was done will present better postoperative olfactory function since the rescue flap requires less nasal mucosal handling and thus less trauma on the olfactory epithelium's region. We will realize a prospective longitudinal study, observing patients undergoing transnasal endoscopic skull base surgery for the removal of tumors or closing of cerebrospinal fistula closure and applying three different questionnaires: CCRC, NOSE, and SNOT-22. (AU)