Per PI request upon data analysis limitation discovery.

The purpose of this study is to compare a subject's sense of smell before and after endoscopic endonasal surgery to remove a skull base abnormality (i.e. tumor, inflammatory process, fracture, defect, etc.) and use the information collected to validate approaches to surgery that will minimize side effects to the sense of smell function. Data will be collected using a smell identification test along with two questionnaires. In addition, demographic, medical history, treatment, outcome, and follow-up information will be collected.

Preoperatively, every patient will undergo an olfactory evaluation using the University of Pennsylvania Smell IdentificationTest (UPSIT), comprising 40 "scratch and sniff" odorants. This test has been validated by age and gender. The test was re-administered at 6 weeks, 3 months, and 6 months following surgery (time window of 62 weeks). Timing of follow-up visits is based on previously published works suggesting that mucosal regeneration is complete in approximately 6 weeks, but return of ciliary function takes about 3 months.17 Furthermore, the reported persistence of nasal crusting up to 100 days after surgery warrants a 6-month (minimum)visit to assess possible delayed recovery of olfaction.

Pertinent data will be collected, including patient demographics, relevant medical/surgical history, and nasal symptoms. Operative data regarding the surgical approach and the type of reconstructive flaps were also recorded. Postoperative course in reference to epistaxis, CSF leak, or need for revision surgery was also documented. To better define the cohort,patients will be categorized into two groups: group I, patients who underwent a nasoseptal flap reconstruction; and group II,patients who underwent rescue flap technique.

Nonparametric data will be analyzed using the Wilcoxon signed rank test and the Mann-Whitney test to allow the intra and intergroup comparison of preoperative and postoperative scores. All statistical analysis will be performed using SPSS v20(IBM, Armonk, NY). All probability values were two-tailed, andP < .05 is considered statistically significant.

Inclusion Criteria:

• Patients presenting with skull base pathologies requiring endonasal surgery at The Ohio State University Wexner Medical Center
• 18 years or older
• Able to consent for self
• Negative serum pregnancy test for women of childbearing potential

Exclusion Criteria:

• Patient unable to return to clinic at specific follow-up times
• Pregnant or nursing
• Prisoners

Adult patients presenting with skull base pathologies requiring endonasal surgery

Fifty consecutive patients were enrolled in the study; however, five patients failed to follow up; thus were excluded from the data analysis. Ten patients underwent reconstruction with an NSF, and the other 35 patients did not. For Group I, mean age was 45.5 yr.

Group II included 18 males and 17 females; mean age 48.9 years.

6 months

There is no risk of serious adverse events, or mortality or other due to the nature of the smell test (it is a scratch and sniff test that includes daily encountered smells. Complications of the surgeries (indications as per standard of care) are not part of the study but were noted and reported.