Diagnosis and treatment of sphenoid sinusitis secondary to endoscopic transnasal skull base surgery

Abstract

Objective To retrospectively analyze the etiology of sphenoid sinusitis secondary to endoscopic transnasal skull base surgery, summarize the characteristics of diagnosis and treatment, and evaluate the prognosis. Methods Clinical data of 24 cases of sphenoid sinusitis secondary to endoscopic transnasal skull base surgery from June 2005 to December 2017 were collected. Endoscpic extended sphenoidectomy was performed to remove the lesion. Nasal CT, MRI, nasal endoscope, Visual Analogue Scale (VAS) and Lund-Kennedy score were used to evaluate the prognosis of patients. Results Clinical symptoms of those patients included headache (21 cases, 87.50%), nasal obstruction (11 cases, 45.83%) and runny nose (9 cases, 37.50% ). Preoperative nasal sinus imaging examinations showed extensive hyperosteogenesis of sphenoid sinus walls and/or discontinuous bone substance of sella turcica, and moderate enhancement of mucosa of sphenoid sinus walls. Intraoperative endoscopic display showed edema, polyp and scar formation of mucosa in posterior ethmoidal sinus and sphenoid sinus. There were significant differences between preoperative and postoperative VAS scores, such as headache (F = 118.961, P = 0.000), nasal obstruction (F = 3.519, P = 0.035) and runny nose (F = 30.563, P = 0.000), and Lund-Kennedy score (F = 26.064, P = 0.000). VAS scores in headache (P = 0.000, for all) and runny nose (P = 0.000, for all) and Lund-Kennedy score (P = 0.000, for all) 3 months and one year after surgery decreased significantly in comparison with before surgery. Conclusions Insufficient surgical field for endoscopic transnasal skull base surgery, inappropriate and unreasonable use of artificial materials can lead to severe sphenoid sinus inflammation and more severe symptoms such as headache, nasal obstruction and runny nose. An extended sphenoidectomy should be adopted under endoscope and the lesions and artificial repair materials must be cleaned, so as to improve the symptoms and achieve mucosal epithelization.

DOI: 10.3969/j.issn.1672-6731.2019.04.008