Sinonasal Outcomes of the Combined Transseptal/Transnasal Approach with Unilateral Nasoseptal Rescue Flap in Endoscopic Endonasal Transsphenoidal Surgery: A Propensity Score Matching Analysis

Objectives  The authors applied surgical techniques acquired during the use of endoscopic combined transseptal/transnasal approach to reduce approach-related morbidity and improve sinonasal outcomes. Study Design  This is a retrospective cohort study of a prospectively collected database. Setting  The study setting involves a tertiary referral center. Participants  A total of 86 patients who underwent endoscopic endonasal transsphenoidal surgery for newly diagnosed pituitary adenomas from April 2018 to March 2021 were included. Patients treated via the combined transseptal/transnasal approach served as the study group (n = 18); those treated via the bilateral transnasal approach comprised the control group (n = 68). From the control group, propensity score matching (PSM) analysis was further performed to account for potential confounders and selection bias. Main Outcome Measures  Paired analysis was performed for pre- and 6-month-postoperative time points in study group, control group, and PSM control group. Olfactory function was evaluated by Connecticut Chemosensory Clinical Research Center (CCCRC) test, Cross-Cultural Smell Identification Test (CCSIT), and sinonasal outcomes were assessed by Sino-Nasal Outcome Test-22 (SNOT-22). Results  In the study group, CCCRC (p = 0.517) and CCSIT (p = 0.497) did not show any significant difference before and after surgery. There was some improvement in the symptom score of SNOT-22, but it was not statistically significant (p = 0.115). In the control group adjusted with PSM, a significant decrease in olfaction (p = 0.047) was observed using CCCRC. The CCSIT score was also decreased but not significant (p = 0.163). Also, there was no difference in the improvement of SNOT-22 (p = 0.781). Conclusion  Our new surgical method preserves olfactory function without compromising surgical outcomes.