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Updated: Mar 24, 2026
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Long-term radiological findings after endonasal endoscopic approach to the skull base
Cristobal Langdon1, Joaquim Enseñat2, Elena Rioja3
1Rhinology Unit and Smell Clinic, Otorhinolaryngology Department, Hospital Clinic, Universitat de Barcelona; Clinical and Experimental Respiratory Immunology, IDIBAPS, Barcelona, Catalonia, Spain.
Objective:
To study the long-term radiological findings after endonasal endoscopic approach to the skull base.
Material And Methods:
Prospective study that included 55 patients who underwent advance endoscopic skull base surgery. All patients were evaluated with MRI before, 3 months and 12 months after surgery. We used the Lund-Mackay staging system for chronic rhinosinusitis to evaluate the paranasal cavities and the sinonasal scoring system to assess sinonasal symptoms.
Results:
Seventeen patients (30.9%) underwent extended endonasal approach that required a nasoseptal flap (NSF) for reconstruction of skull base. At baseline the mean total Lund-Mackay score was 0.63 ± 1.2 (range 0-4), and at 3 and 12 months postoperatively the mean scores were 3.5 ± 3.8 (range 0-14) and 2.0 ± 2.5 (range 0-8) respectively. Patients who needed an NSF for reconstruction had a greater Lund-Mackay score (p<0.05). Moreover, NSF is correlated with sinonasal mucosal thickening and fluid retention at 3 months (r=0.45, p<0.01) and 12 months (r=0.4, p<0.01). Total 5-symptom score (T5SS) was similar between both groups at baseline. Patients with extended endoscopic approach reported more smell loss (40.1 ± 26.2; p<0.05) and posterior nasal discharge (49.3 ± 30.1; p<0.05) than TTEA patients (21.6 ± 30.9 and 22.5 ± 27.5 respectively).
Conclusions:
We observed that sinus opacity is still present after one year of advance endoscopic skull base surgery but symptoms seems to return to basal after 12 months of follow-up.
