The Expanded Endonasal Approach: Does Greater Exposure Change Rhinologic Outcomes?
Notice bibliographique
Résumé
Objective: This study was aimed to investigate the postoperative sinonasal outcomes of patients who have undergone a widely expansive expanded endonasal approach. Methods: A retrospective chart review of patients who had undergone a widely expansive expanded endonasal approach procedure by a single skull base surgery team between June 1, 2016 and June 1, 2019 was completed. Inclusion criteria were only those patients that completed a Sinonasal outcome test-22 (SNOT-22). Our approach was characterized by either a uninostril or a binostril technique with a posterior septectomy, depending on the lesion location. If a skull base defect was present, a nasoseptal or pericranial flap was used. An abdominal fat graft was also employed as a biologic dressing when an intraoperative cerebrospinal fluid (CSF) leak presented. Patients were seen preoperatively and 1, 2, and 4 weeks postoperatively. They were also seen for follow-up at 3, 6, and 12 months postoperatively. Postoperative care included debridements at 1-, 2-, and 4-week follow-up clinic visits. Each patient had nasal packing and antibiotics postoperatively. Packing was removed within the first week after surgery. Once packing was removed, patients were instructed to use a NeilMed rinse bottle with saline rinse at minimum six times per day until advised to discontinue usage. Fat grafts were removed at the third postoperative visit, 4 weeks after surgery. Preoperative SNOT scores were compared with scores collected at each postoperative clinic visit. The patient population was divided between individuals that underwent a uninostril approach or a binostril approach to determine if there was any difference between the two groups 6 months post-surgery. Chi-squared analysis was also used to compare possible differences in patient outcomes based on collected patient demographic information including gender, age, whether they were diabetic, depressed, anxious, and using immunocompromising or topical medications. Results: Only 139 skull base surgeries with an associated SNOT score were completed during the 3-year review period. There was no significant difference in total, rhinological or quality of life patient outcomes, measured via SNOT-22 scores, at least 6 months postoperatively when compared with preoperative scores ( p = 0.157). Comparison of uninostril vs. binostril approaches also did not show any significant difference in outcomes at least 6 months after surgery ( p = 0.5353). There was no statistical difference between groups based on reconstruction method. Conclusion: The widely expansive expanded endonasal approach with active postoperative care does not appear to affect long-term rhinological or quality of life patient outcomes. The benefits of our approach include increased operative dexterity, topical delivery of postoperative medication, and visualization of pathology.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».