Work-related musculoskeletal disorders among endoscopic transsphenoidal surgeons: a systematic review of prevalence and ergonomic interventions

Endoscopic transsphenoidal surgery is a surgical technique introduced in the last 20 years for the treatment of skull base pathologies and, in particular, pituitary tumours. Although the prevalence of work-related musculoskeletal disorders is usually significantly higher in endoscopists and minimally invasive surgeons compared to other surgical and medical specialties, reviews on the prevalence of disorders among neurosurgeons dedicated to endoscopic transsphenoidal surgery are not available. This article performs a systematic review to identify the work-related musculoskeletal disorders among transsphenoidal neurosurgeons, their prevalence and the ergonomic interventions proposed to reduce risk factors and prevent disorders. The results show that the ergonomics of transsphenoidal neurosurgeons is an under-investigated topic. Indeed, specific prevalence data are not available. In addition, only a few papers suggest interventions and guidelines, but without objective assessment of the outcomes to confirm the ergonomic benefit. Based on these gaps in the literature, a future research agenda is proposed.

Endoscopic Endonasal Anterior Skull Base Surgery: A Systematic Review of Complications During the Past 65 Years

BACKGROUND

Endoscopic skull base surgery is becoming more popular as an approach to the anterior skull base for tumors and cerebrospinal fluid (CSF) fistulae. It offers the advantages of better cosmesis and improved quality of life after surgery. We reviewed the complication rates reported in the literature.

METHODS

A literature search was performed in the electronic database Ovid MEDLINE (1950 to August 25, 2015) with the search item "([Anterior] AND Skull base surgery) AND endoscopic."

RESULTS

We identified 82 relevant studies that included 7460 cases. An average overall complication rate of 17.1% (range 0%-68.0%) and a mortality rate of 0.4% (0%-10.0%) were demonstrated in a total of 82 studies that included 7460 cases. The average CSF leak rate for all studies was 8.9% (0%-40.0%) with meningiomas and clival lesions having the greatest CSF leak rates. The most frequent benign pathology encountered was pituitary adenomas (n = 3720, 49.8% of all cases) and the most frequent malignant tumor was esthesioneuroblastoma (n = 120, 1.6% of all cases). Studies that included only CSF fistula repairs had a lower average total complication rate (12.9%) but a greater rate of meningitis compared with studies that reported mixed pathology (2.4% vs. 1.3%). A trend towards a lower total complication rate with increasing study size was observed.

CONCLUSIONS

The endoscopic approach is an increasingly accepted technique for anterior skull base tumor surgery and is associated with acceptable complication rates. Increasing experience with this technique can decrease rates of complications.

Long-term outcomes of endoscopic endonasal approach for skull base surgery: a prospective study

Little is known about the long-term effects of either transnasal transsphenoidal endoscopic approach (TTEA) or expanded endonasal approach (EEA). This study assessed the long-term impact of endoscopic skull base surgery on olfaction, sinonasal symptoms, mucociliary clearance time (MCT), and quality of life (QoL). Patients with pituitary adenomas underwent TTEA (n = 38), while patients with other benign parasellar tumours who underwent an EEA with vascularised septal flap reconstruction (n = 17) were enrolled in this prospective study between 2009 and 2012. Sinonasal symptoms (Visual Analogue Scale), subjective olfactometry (Barcelona Smell Test-24, BAST-24), MCT (saccharin test), and QoL (short form SF-36, rhinosinusitis outcome measure/RSOM) were evaluated before, and 12 months after, surgery. At baseline, sinonasal symptoms, MCT, BAST-24, and QoL were similar between groups. Twelve months after surgery, both TTEA and EEA groups experienced smell impairment compared to baseline. Moreover, EEA (but not TTEA) patients reported increased posterior nasal discharge and longer MCTs compared to baseline. No significant changes in olfactometry or QoL were detected in either group 12 months after surgery. Over the long-term, expanded skull base surgery, using EEA, produced more sinonasal symptoms (including loss of smell) and longer MCTs than pituitary surgery (TTEA). EEA showed no long-term impact on smell test or QoL.

LEVEL OF EVIDENCE

IIb.