Surgery Clinical Trial
Official title:
Impact of Nasoseptal Flap Harvest Technique on Olfaction Following Endoscopic Transsphenoidal Pituitary Surgery: A Single-blinded Randomized Controlled Trial
Pituitary tumours have an estimated prevalence of 20% in the general population and the
number of clinically relevant pituitary adenomas is increasing with time. When symptomatic,
the standard of care required for pituitary adenomas is resection through an endoscopic
transsphenoidal approach. There is however significant olfactory dysfunction following
endoscopic transsphenoidal pituitary surgery with approximately 23% of patients reporting
some degree of worsening in their sense of smell in the postoperative period.
Pedicled nasoseptal flaps are used to repair skull base defects following resection of skull
base tumours. The superior incision is placed in close proximity to olfactory mucosa.
Currently, these flaps are raised either with the use of electrocautery or scalpel. The use
of electrocautery in surgery has provided surgeons with greater hemostasis when compared to a
scalpel. This is of utmost importance in many regions of the head & neck where highly
vascularized tissue results in difficulties achieving adequate hemostasis and therefore
limiting view of the surgical field. However, the use of electrocautery increases thermal
damage to surrounding tissue and impairs wound healing when compared to a scalpel.
Although the transmission of thermal energy via electrocautery to adjacent mucosa containing
olfactory epithelium may theoretically contribute to olfactory disturbances, no prospective
randomized controlled trials have yet examined the impact of these two different techniques
on postoperative olfactory function. The purpose of this research study is to determine the
effects, if any, of electrocautery versus scalpel on olfaction in raising the nasoseptal flap
for repairing skull base defects following transphenoidal surgery.
Status | Recruiting |
Enrollment | 20 |
Est. completion date | December 31, 2019 |
Est. primary completion date | October 31, 2019 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Adult patients (age =18 years) - Patients with tumours of the pituitary gland electively scheduled for endoscopic transsphenoidal surgery with nasoseptal flap coverage Exclusion Criteria: - Documented evidence of sinonasal disease on either nasal endoscopy or radiography - Patients with a clinical history of asthma and/or sinonasal disease - Previous sinus surgery - Previous skull base surgery - History of pre-existing hyposmia or anosmia - Use of medication(s) known to alter sense of smell at time of test - UPSIT scores <5 indicating a functional component to alteration in olfaction - Development of postoperative cerebrospinal fluid leak necessitating re-entry into the operative field containing the nasoseptal flap |
Country | Name | City | State |
---|---|---|---|
Canada | St. Michael's Hospital | Toronto | Ontario |
Lead Sponsor | Collaborator |
---|---|
St. Michael's Hospital, Toronto |
Canada,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Change in University of Pennsylvania Smell Identification Test (UPSIT) | Standardized and validated test of olfaction, which uses microencapsulated odorants released by scratching test booklets. Participants are asked to fill out forced choice multiple alternative questionnaires regarding each odorant. Minimum total score 0, maximum total score 40. Higher scores represent a better outcome. | Initial visit and at 1, 3 and 6-month follow-up visits | |
Primary | Change in Sniffin' Sticks | Validated 16-item odor identification test. Minimum total score 0, maximum total score 16. Higher scores represent better outcome. | Initial visit and at 1, 3 and 6-month follow-up visits | |
Primary | Change in Sino-Nasal Outcome Test-22 (SNOT-22) | Disease-specific, quality-of-life related measure of sinonasal function. Test consists of 22 symptoms requiring responders to rate severity on a 5-point Likert scale 0-5. Minimum score 0, maximum score 110. Higher scores correlate with greater rhinosinusitus-related health burden. | Initial visit and at 1, 3 and 6-month follow-up visits | |
Primary | Change in Skull Base Inventory (SBI) | Multidimensional, disease-specific instrument designed to measure quality of life of patients who undergo surgical treatment for anterior or central skull base pathologies. It covers several disease-specific domains including cognitive, endocrine, nasal, neurologic, visual, and other general areas.Each item is weighted equally in each domain score. Each domain is weighted equally in the overall score. Domain scores are calculated by taking the total score (sum of all items) in that domain divided by the maximum possible score for that domain multiplied by 100. The minimum score for each domain is 0 and the maximum is 100. The minimum score for the questionnaire is 0 and the maximum is 100. Higher score indicates better outcomes. | Initial visit and at 1, 3 and 6-month follow-up visits | |
Primary | Change in Pre-Op and Post-Op Endoscopy Scores | Used to quantify the pathological states of the nose and paranasal sinuses. Calculated on left and right side out, minimum 0, maximum 14. Higher scores indicate objectively worse sinonasal inflammation. | Initial visit and at 1, 3 and 6-month follow-up visits |
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