Nasal Morbidity Following Endoscopic Endonasal Skull Base Surgery: A Retrospective Study

Objective: To quantify nasal morbidity associated with endoscopic endonasal skull base surgery.

Design: Retrospective analysis of the first 151 cases of endoscopic endonasal skull base surgery performed in our unit between 2007 and 2011. All patients answered a standardized survey via telephone interview.

Patients: Of the 151 cases, 75 were men. The mean age was 55.2 years. Eighty-five cases underwent pituitary tumor surgery, and the remaining underwent a variety of anterior skull base procedures. We had an 82% response rate and a median follow-up period of 17 months (range, 2–60 months).

Results: Postoperatively, 65.3% reported a normal sense of smell and 3.2% reported no sense of smell.

Also, 91.9% reported nil or mild nasal blockage after surgery. Complete nasal blockage was more common in the pituitary tumor group, 9.9%, versus 5.9% for the other procedures (P value, 0.43).

Overall, 91.1% reported nil or mild nasal discharge postoperatively. Of those with severe discharge, it was more common in the nonpituitary tumor group, 13.7% versus 5.6% for the other procedures (P value, 0.124). For those who experienced discharge, 75.9% reported resolution within 8 weeks.

Nil or mild nasal crusting was reported in 76.6%, moderate in 20.2%, and severe in 3.2%. In 66.7%, nasal crusting resolved within 8 weeks.

Nil or mild nasal pain was reported in 96.0% of cases, which lasted a median of 9 days (range, 3–365 days).

Conclusions: The largest study on nasal morbidity following endoscopic endonasal approach was by the Pittsburgh group in 2010. Our study suggests a low level of nasal morbidity, with no statistically significant difference between pituitary and other skull base pathology groups. The information in this study will help inform patients more accurately.