Symptomatic Keratoconjunctivitis Sicca Is Rare after Vidian Neurectomy during Expanded Endonasal Skull Base Approaches

Document Type

Conference Proceeding

Publication Date

2-5-2024

Publication Title

J Neurol Surg B Skull Base

Abstract

Introduction: Keratoconjunctivitis Sicca (KCS) or dry, irritated eyes due to lack of tear production, can be very uncomfortable to patients and require ongoing medical treatments to avoid ocular complications. Autoimmune or other disorders that affect the lacrimal gland are associated with KCS. The secretory function of the lacrimal gland is innervated by sympathetic and parasympathetic fibers by way of the nerve of the pterygoid canal, or Vidian nerve. Vidian neurectomy has been used as a treatment for refractory allergic rhinitis and other sinonasal conditions, taking advantage of the augmentation of autonomic innervation. Previous studies have shown that vidian neurectomy can reduce tear production for at least two months after the procedure. Due to this important role in lacrimation, the vidian nerve is often preserved during transcranial skull base approaches. However, in the era of expanded endoscopic endonasal approaches (EEAs), vidian neurectomy is often necessary to safely expose the anterior cavernous sinus dura, cavernous carotid artery, foramen lacerum and adjacent structures. Objective: The objective of this report is to determine the safety of vidian neurectomy during endoscopic endonasal skull base surgery, specifically with regard to the incidence of symptomatic dry eyes (KCS) in patients who have undergone vidian neurectomy during expanded EEA. Methods: Cases of a single neurosurgeon between October 2022 and July 2023 were retrospectively reviewed to identify patients who underwent vidian neurectomy as part of an endonasal skull base approach. These patient records were reviewed in detail with attention to reports of KCS symptoms at postoperative follow up as well as postoperative ophthalmology encounters. Results: 13 patients (Female = 7) underwent vidian neurectomy as part of expanded EEA during the study period (left = 3; right = 9; bilateral = 1). The pathologies for which the surgery was performed were pituitary adenoma (N = 8), as well as chordoma (N = 2), meningioma (N = 1), squamous cell carcinoma (N = 1), and fibrous dysplasia (N = 1). No patients reported symptomatic dry eyes at initial neurosurgery follow up at 2 weeks or any subsequent visits. Three patients did see ophthalmology postoperatively for routine follow up of baseline visual deficits or cranial neuropathies but were not found to have any new symptoms related to KCS. Conclusions: Vidian neurectomy is necessary to adequately expose parasellar structures during expanded endonasal approaches to the cavernous sinus or adjacent structures. The procedure is well-tolerated, and clinical symptoms of KCS following vidian neurectomy were not observed in any of our patients.

Volume

85

Issue

S1

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