Transnasal Endoscopic Pituitary Surgery - the Effect of Posterior Nasal Septum Resection on Nasal Functions
Transnasal Endoscopic Pituitary Surgery - the Effect of Posterior Nasal Septum Resection on Nasal Functions
The aim of the project is to compare the effect of different extent of resection of the
 posterior part of the septum on the postoperative nasal functions.
The nasal cavity is used to heat, humidify and purify the air before entering other parts of
 the respiratory system. Other functions of the nose include in particular olfactory, immune,
 reflex or sexual functions.

 Proper airflow through the nasal cavity is essential for all nasal functions; anatomical or
 flow changes can significantly affect nasal functions.

 Endoscopic transnasal surgical approaches are modern, mini-invasive methods, enabling
 solution of pathologies in the area of the cranial base, through the nasal cavity. The
 advantage of this technique is absence of external incisions and scars and significantly
 better cosmetic effect, these methods also offer very good clarity and illumination of the
 operating field. Main disadvantage is risk of affecting functions of the nose.

 To create a transnasal approach to skull base, it is necessary to perform lateralization of
 middle turbinates, resection of anterior wall of sphenoidal sinus and resection of posterior
 part of the nasal septum. These interventions are necessary for a good overview and
 manipulation in the operated area; however, they can lead to postoperative changes in the
 physiological functions of the nasal cavity, especially loss of smell, taste, altered airflow
 through the nasal cavity, mucociliary transport disorders, nasal obstruction, crusting or
 drying mucous membrane. All these adverse changes significantly affect patient's quality of
 life.

 Larger extent of septal resection allows the surgeon to have a better overview and
 manoeuvrability in the operated area, which allows sufficient radicality and allows the
 solution of possible complications. On the other hand, greater resection also means greater
 interference with the anatomy of the nasal cavity and possible influence on nasal functions.

 The aim of the project is to compare the effect of different extent of resection of the
 posterior part of the septum on the postoperative nasal functions.

 Study design:

 -  all operations will be performed by the same operations team

 -  prior to surgery, patients will be randomly tossed into two groups according to the
 extent of resection of the posterior edge of the septum as part of the transsphenoidal
 approach during cranial base surgery

 -  group A - Patients will be resected with a posterior 1 cm nasal septum as part of a
 transsphenoidal approach.

 -  group B - Patients will be resected with a 2 cm posterior nasal septum as part of a
 transsphenoidal approach

 -  if the selected extent of resection is not sufficient during surgery for group A, it
 will be extended so that the lesion can be safely removed, and patient will be removed
 from study

 Operational procedure:

 1. Anemization of the nasal mucosa using strips with diluted adrenaline 1: 1000.

 2. Endoscopy of the nasal cavity and identification of important anatomical structures.

 3. Lateralization of the middle and upper turbinates, identification of the anterior wall
 of the sphenoidal sinus and its natural ostium.

 4. Apply suction with a marked distance of 1 and 2 cm to the septum and mark the extent of
 laser resection on the septal mucosa.

 The suction is applied paraseptally to the anterior wall of the sphenoidal sinus at the
 height of the natural ostium (1.5 cm above the upper edge of the choana), the caudal
 border of the resection is the height of the upper edge of the choana, the cranial
 border is the ceiling of the sphenoid.

 5. Resection of the septum in the given range.

 6. Resection of the anterior wall of the sphenoidal sinus, resection of the intersphenoidal
 septum.

 7. Rest of the operation is identical in both groups of patients (tumour resection,
 revision of the nasal cavity, nasal tamponade).

 -  At preoperative examination and 1 month after surgery, patients will have:

 -  endoscopy of the nasal cavity with Lund-Kennedy scoring system (evaluation of
 oedema, secretion, crust)

 -  olfactory examination - test of identification and discrimination with perfumed
 markers

 -  SNOT 22 questionnaire

 -  RhinoVAS questionnaire

 -  Nose score

 Statistical evaluation:

 -  comparison of nasal functions after cranial base surgery in patients with a range of
 resection of the posterior edge of the septum 1 cm and 2 cm

 -  comparison of olfactory before and after surgery in both groups of patients
Inclusion Criteria:

 -  age over 18 years

 -  patients with functional pituitary adenoma indicating endoscopic transnasal
 extirpation of the pituitary adenoma

 Exclusion Criteria:

 -  patients after surgery of the nasal cavity or base of the skull

 -  patients with nasal disease and PND

 -  patients with olfactory disorders before surgery

 -  patients with nasal septal deviation