PMID- 32551920
OWN - NLM
STAT- MEDLINE
DCOM- 20210818
LR  - 20210818
IS  - 1945-8932 (Electronic)
IS  - 1945-8932 (Linking)
VI  - 35
IP  - 1
DP  - 2021 Jan
TI  - Using the Middle Turbinate to Protect the Skull Base in Endoscopic 
      Transsphenoidal Surgery: A Cadaver Study.
PG  - 59-63
LID - 10.1177/1945892420933173 [doi]
AB  - Inadvertent intracranial injury from nasogastric tube (NGT) placement is a 
      described and potentially fatal complication following endoscopic transsphenoidal 
      hypophysectomy (TSH). This cadaver study assessed the role of middle turbinate 
      (MT) preservation and medialization in preventing accidental skull base injury 
      from NGT insertion after TSH. Methods: Standard approach for TSH was performed on 
      3 human cadavers. MTs were placed into neutral position (MTN), then medialized 
      via suture pexy to the septum (MTP), and subsequently resected (MTR). After each 
      stage, 3 blinded individuals passed a 10 F Dobhoff and a 16 F NGT on each side of 
      each cadaver (5 passes per side). Using endoscopic visualization, each pass was 
      scored by a blinded reviewer based on the first contact point of the tube 
      (0 = nasopharynx, 1 = inferior sphenoid face, 2 = sphenoid sinus), with higher 
      scores suggestive of increased risk of intracranial injury. Results: There were 
      270 Dobhoff and 270 NGT passes scored. Data was divided into 3 groups based on 
      presence and position of the MT. Significant differences were demonstrated 
      between all three groups [one-way ANOVA: Dobhoff F(2,267) = 6.981, p = 0.001], 
      [NGT F(2,267) = 17.582, p < 0.001]. There were significant differences between 
      means for MTN versus MTP groups [Dobhoff (0.43 vs 0.22, p = 0.007), NGT (0.73 vs 
      0.28, p < 0.001)] and MTP versus MTR groups [Dobhoff (0.22 vs 0.55, p < 0.001), 
      NGT (0.28 vs 0.81, p < 0.001)], indicating that the presence and position of the 
      MT can significantly affect the accessibility of the sphenoid sinus interior 
      after TSH. There was a trend toward lower means in the MTN group compared to the 
      MTR group. Conclusion: MT preservation and deliberate medialization against the 
      septum may reduce risk of inadvertent intracranial NGT injury in postop TSH 
      patients. This simple maneuver should be considered in all routine TSH 
      procedures.
FAU - Shah, Janki
AU  - Shah J
AUID- ORCID: 0000-0001-6172-6508
AD  - Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, 
      Cleveland Clinic, Cleveland, Ohio.
FAU - Tang, Dennis
AU  - Tang D
AUID- ORCID: 0000-0003-2315-9930
AD  - Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, 
      Cleveland Clinic, Cleveland, Ohio.
FAU - Grafmiller, Kevin
AU  - Grafmiller K
AUID- ORCID: 0000-0001-9238-6569
AD  - Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, 
      Cleveland Clinic, Cleveland, Ohio.
FAU - Cappello, Zachary J
AU  - Cappello ZJ
AD  - Department of Otolaryngology-Head and Neck Surgery, Charlotte Eye, Ear, Nose and 
      Throat, Charlotte, North Carolina.
FAU - Roxbury, Christopher
AU  - Roxbury C
AD  - Rhinology and Endoscopic Skull Base Surgery, Department of Surgery, Section of 
      Otolaryngology-Head and Neck Surgery, University of Chicago Medicine and 
      Biological Sciences, Chicago, Illinois.
FAU - Sindwani, Raj
AU  - Sindwani R
AD  - Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, 
      Cleveland Clinic, Cleveland, Ohio.
AD  - Minimally Invasive Cranial Base and Pituitary Surgery, Rosa Ella Burkhardt Brain 
      Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio.
LA  - eng
PT  - Journal Article
DEP - 20200619
PL  - United States
TA  - Am J Rhinol Allergy
JT  - American journal of rhinology & allergy
JID - 101490775
SB  - IM
MH  - Cadaver
MH  - *Endoscopy
MH  - Humans
MH  - Skull Base/surgery
MH  - Sphenoid Sinus/surgery
MH  - *Turbinates
OTO - NOTNLM
OT  - Dobhoff
OT  - cadaver
OT  - complication
OT  - endoscopic
OT  - inadvertent
OT  - intracranial placement
OT  - middle turbinate
OT  - nasogastric tube
OT  - skull base protection
OT  - transsphenoidal hypophysectomy
EDAT- 2020/06/20 06:00
MHDA- 2021/08/19 06:00
CRDT- 2020/06/20 06:00
PHST- 2020/06/20 06:00 [pubmed]
PHST- 2021/08/19 06:00 [medline]
PHST- 2020/06/20 06:00 [entrez]
AID - 10.1177/1945892420933173 [doi]
PST - ppublish
SO  - Am J Rhinol Allergy. 2021 Jan;35(1):59-63. doi: 10.1177/1945892420933173. Epub 
      2020 Jun 19.