Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.
Int Forum Allergy Rhinol. 2013 Jan;3(1):62-5. doi: 10.1002/alr.21069. Epub 2012 Aug 2.
Postoperative hyposmia and anosmia is an often overlooked complication of endoscopic pituitary surgery. Septal flaps have been utilized as a strategy for repairing and preventing postoperative cerebrospinal fluid (CSF) leaks. The olfactory impact of raising this flap for sellar reconstruction and CSF repair needs qualitative assessment. This study aims to ascertain the effect of the Hadad-Bassagasteguy (HB) flap on olfaction in endoscopic pituitary surgery.
In this randomized controlled trial, patients undergoing pituitary surgery underwent computerized randomization. Those in Group 1 all had HB flaps raised and placed for sellar floor defects. Those in Group 2 underwent reconstruction with synthetic or nonautologous materials. The University of Pennsylvania Smell Identification Test (UPSIT) was administered preoperatively and 6 months postoperatively. Results were analyzed using nonparametric tests.
Twenty subjects were enrolled, 10 in each group. Eight subjects in Group 1 vs 3 in Group 2 had intraoperative CSF leak. All were repaired intraoperatively and none required additional intervention. Preoperatively, UPSIT scores were not significantly different between groups (p = 0.62). Preoperative vs postoperative comparisons were significant for a decrease in scores in both groups postoperatively (Group 1, p < 0.001; Group 2, p < 0.001). Those undergoing HB flap reconstruction had significantly worse scores postoperatively (p = 0.001).
Endoscopic pituitary surgery results in decreased olfaction with or without deploying a septal flap. However, use of the HB flap for reconstruction can worsen hyposmia at least 6 months after surgery. Olfaction should be considered when use of the HB flap is planned.
术后嗅觉减退和嗅觉丧失是内镜垂体手术中经常被忽视的并发症。鼻中隔瓣已被用作修复和预防术后脑脊液（CSF）漏的策略。为鞍底重建和 CSF 修复而掀起此瓣对嗅觉的影响需要进行定性评估。本研究旨在确定 Hadad-Bassagasteguy（HB）瓣对内镜垂体手术中嗅觉的影响。
在这项随机对照试验中，接受垂体手术的患者接受了计算机随机分组。第 1 组所有患者均行 HB 瓣掀起并置于鞍底缺损处。第 2 组患者采用合成或非自体材料进行重建。术前和术后 6 个月进行宾夕法尼亚大学嗅觉识别测试（UPSIT）。使用非参数检验分析结果。
共纳入 20 例患者，每组 10 例。第 1 组 8 例患者术中发生 CSF 漏，第 2 组 3 例。所有患者均在术中修复，无患者需要额外干预。术前两组 UPSIT 评分无显著差异（p = 0.62）。两组术后评分均显著下降（第 1 组，p < 0.001；第 2 组，p < 0.001），且术前比较有统计学意义。行 HB 瓣重建的患者术后评分明显更差（p = 0.001）。
内镜垂体手术可导致嗅觉减退，无论是否使用鼻中隔瓣。然而，使用 HB 瓣进行重建至少在术后 6 个月后可能会使嗅觉减退恶化。在计划使用 HB 瓣时应考虑嗅觉。
