| OBJECTIVE:Based on preoperative and postoperative evaluation of the olfactory function and nasal quality of life in patients with endoscopic endonasal approach for skull base tumors,to explore the influence of HB flap reconstruction on olfactory function and nasal quality of life in patients who underwent endoscopic endonasal approach.This study will provide certain theoretical basis in clinical diagnosis,preoperative predictions and approach selections.METHODS:One hundred and nine patients with skull base tumors who underwent endoscopic endonasal surgery in the neurosurgery department of our hospital from July 2015 to June 2016 were included in this study.Data were collected in detail on age,sex,residence,work environment,education background,history of nasal disease and nasal medication.Cases with pituitary adenoma,craniopharyngioma,chordoma,Rathke cyst,trigeminal schwannoma,other base of skull lesions(germinoma,metastatic encephaloma,nasopharyngeal carcinoma,cavernous hemangioma in cavernous sinus)were included.The patients were divided into two groups according to the type of reconstruction(with or without HB flap):HB flap group(n=47)and the non-HB flap group(n=62).All patients were evaluated with the T&T olfactometer test before surgery and 1 week,3 months and 6 months after surgery.The ASK Nasal Inventory-12 scale was carried out on two groups before surgery and 1 week,3months and 6 months after surgery.SPSS(version 21.0)was used for statistical analyses.To evaluate the impact of HB flap elevation on olfactory function and nasal quality of life.RESULTS:1.The results of the T&T olfactometer test showed that preoperatively45(95.74%)and 59(95.16%)patients were normal in HB flap group and non-HB flap group respectively.There was no significant difference between two groups(P>0.05).But the results at 1 week after surgery showed that all cases appeared different degree of smell disorders.95.74% and 96.77% of the patients had severe hyposmia ~anosmia(? ~ ? level)in HB flap and the non-HB flap group respectively.There was also no significant difference between two groups(P>0.05).2.The overall olfactory function was improved at 3 months after surgery,and further improvement was showed at 6 months after surgery.No significant differences were found between two groups at both time points(P<0.05).The olfaction had not been returned to the preoperative levels at 6months after surgery,but 68.09% and70.97% of the patients recovered to at least mild hyposmia in HB flap group and nonHB flap respectively.In the non-HB flap group,93.5% of the patients returned to at least moderate hyposmia at 3 months after surgery.However,95.7% of the patients returned to at least moderate hyposmia at 6 months after surgery.3.The mean of rank-sum in HB flap group and non-HB flap group at preoperative and 1 week,3 months,6 months after surgery respectively were 54.82?55.14,56.91?53.55,67.55?45.48,56.39?53.94.There was no significant difference at preoperative and 1 week,6 months after surgery between two groups(? Z ?=0.144,P=0.886?? Z?=0.693,P=0.488 ??Z?=0.444,P=0.657).However,the HB flap group show significant improvement compared to the non-HB flap group that 29.78% and 6.45% of the patients had severe hyposmia ~ anosmia(? ~ ?level)in both groups respectively.In addition,no significant differences were found between two groups(?Z?=3.830,P=0.000).4.The results of the ASK Nasal Inventory-12 showed that there was a significant increase in the ASK Nasal Inventory-12 scores at 1 week after endoscopic endonasal surgery in both groups.The ASK Nasal Inventory-12 score was declined at three months postoperatively comparing against preoperative scores.And the score was further decreased to almost preoperative level comparing against three months postoperatively.The preoperative ASK Nasal Inventory-12 scores were compared against 1 week,3 months,6 months after surgery scores which showed a statistically significant difference(P<0.05).5.There was no significant difference in ASK Nasal Inventory-12 scores at preoperative and all postoperative evaluations between two groups(P>0.05).CONCLUSIONS:1.A significant decline in the T&T olfactometer test and ASK Nasal Inventory-12 scores at 1 week after endoscopic endonasal surgery with or without deploying a HB flap in all cases were observed.2.There was a significant decline in the T&T olfactometer test scores at 1 week after endoscopic endonasal surgery.There was apparent recovery of olfactory function at 1 week after surgery for most of the patients in the non-HB flap group.However,in the HB group,the HB flap for reconstruction could worsen hyposmia at least 6 months after surgery.In most of the patients,although olfactory function did not return to the preoperative levels by 6 months after surgery,there was no significant difference in the T&T olfactometer test scores between two groups.And it is uncertain whether further recovery is possible or not.3.There was no significant difference in ASK Nasal Inventory-12 scores at all postoperative evaluations between two groups,indicated that utilization of the HB flap for reconstruction was not a risk to worsen nasal quality of life. |
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