Added Sinonasal Morbidity of Transpterygoid Approach versus Transsphenoidal Approach: A Case-Controlled Analysis

Area of Science:

• Neurosurgery
• Otolaryngology
• Skull Base Surgery

Background:

• Endoscopic endonasal skull base surgery frequently combines the transsphenoidal (TS) and transpterygoid (TP) approaches.
• The TP approach extends surgical access to lateral skull base regions.

Purpose of the Study:

• To investigate the sinonasal morbidity associated with the combined TS + TP approach compared to the TS approach alone.
• To assess the long-term impact on sinonasal quality of life.

Main Methods:

• Retrospective analysis of 70 adult patients undergoing TS or TS + TP approaches (2018-2023).
• Sinonasal quality of life measured using the Sinonasal Outcome Test (SNOT-22) preoperatively and at 2, 6, and 12 weeks postoperatively.
• Comparison of SNOT-22 scores between the two surgical cohorts.

Main Results:

• Both groups showed a temporary increase in SNOT-22 scores at 2 weeks, which normalized by 6-12 weeks.
• No statistically significant differences in sinonasal morbidity were found between the TS and TS + TP groups at any time point.
• Middle turbinate (MT) sacrifice was associated with significantly higher SNOT-22 scores, indicating worse sinonasal outcomes.

Conclusions:

• The addition of the transpterygoid approach to the transsphenoidal approach does not increase long-term sinonasal morbidity.
• The combined approach offers a viable option for expanded surgical exposure without compromising long-term sinonasal quality of life.
• Further research with extended follow-up is warranted to validate these findings.