Comparasion of the anatomic and therapeutic effect of two transsphenoidal approaches under neuroendoscopy

Objective: To compare anatomical parameters, postoperative nasal complications and quality of life of 2 sphenoid sinus approaches (nasal septum approach and transsphenoidal anterior wall approach) via anterior wall by endoscopic surgery. Methods: The study was anatomic basis research and prospective randomized double-blind (Clinical trials registration number: NFEC-2015-033). Study was performed in 30 dissected heads via 2 approaches. The related anatomic parameters were measured. Another 60 patients with pituitary tumor were randomly divided into 2 groups to receive endoscopic surgery. The selected otolaryngologist and non-operative neurosurgeon common then analyzed preoperative indicators. The therapeutic effect and nasal complications of 2 transsphenoidal approaches were compared by Lund-Kennedy scale, Lund-Mackay scale and SNOT-20 scale. Results: The distances between incision and external nostrils of anterior wall in nasal septum approach and transsphenoidal anterior wall approach are 5.19 & PLUSMN; 0.15 versus 6.91 & PLUSMN; 0.14 cm, respectively; maximum angles and ranges of swing in horizontal direction on operative route are 44.77 & PLUSMN; 2.04 degrees versus 38.54 & PLUSMN; 1.40 degrees, and 1.25 & PLUSMN; 0.15 versus 0.59 & PLUSMN; 0.52 cm. The operation time in nasal septum approach group is shorter (61.97 & PLUSMN; 18.123 min) than transsphenoidal anterior wall approach group (89.83 & PLUSMN; 38.515 min); And higher Lund-Kennedy score (2.4737 & PLUSMN; 1.46699 vs 3.8125 & PLUSMN; 1.51520. In addition, 20 Subjective Scoring Scales for Nasal and Paranasal Sinus Outcome (SNOT-20) measurement results indicated nasal septum approach group has less subjective symptoms plague patients' lives. The cerebrospinal fluid leakage, resection of tumor, postoperative endocrine remission rate and postoperative complications occurred in 2 groups have no significant difference. Conclusion: Endonasal transsphenoidal via nasal septum-sphenoid sinus approach has characters of less surgery damage, short distance to the outside of the nose, precise location, wider operation space and larger perspective, which is obvious advantages in reducing postoperative nasal complications.