Trans-nasal microscopic resection of olfactory nerve filaments for 16 patients of parosmia: operative and neuropathological results
Tomokatsu Hori, Haruko Yoshimoto and Hajime Miyata
Tokyo Neurological Center Hospital, Japan
Research Institute for Brain and Blood Vessels, Japan
: J Otol Rhinol
Severe parosmia is life disturbing disease. The authors have operated 16 patients of severe parosmia for recent 13 years. The operative method is complete resection of olfactory nerve filaments at the level of ethmoidal fossa by trans-nasal microsurgical approach. For those of unilateral parosmia, unilateral total resection of olfactory nerves has been done, but for those of bilateral parosmia, bilateral complete resection of the olfactory nerves has been accomplished. The age of operative time ranged from 18 years to 77 years, and there are eight men and 8 women. Among the patients, there was a moderate degree of head trauma history in 11 patients (68%), and high grade upper respiratory infection was observed in three patients (19%). The beginning of disease to the time of operation ranged from one year to twenty years. For these 16 patients, post-operative immediate complete relief of parosmia has been obtained. But two patients have recurrence of parosmia in 2 months and 20 months respectively after operation, and required to be re-operated. But other 14 patients are almost free of recurrence or with even slight recurrence; parosmia is tolerable, not to be re-operated. In these recurrent patients, residual or newly formed nerves were observed and resected. In these two patients, parosmia disappeared postoperatively until now. Concerning patients’ satisfaction, 15 patients are satisfied with the operative results, but one patient is complaining about postoperative anosmia. Regarding olfactory function, three patients reported some recurrence of olfactory sensation at the operative side. Neuropathological findings of resected nerve and mucosa will be also presented in this communication. Conclusion: In conclusion, microsurgical trans-nasal resection of olfactory nerve filaments at the ethmoid level is effective for severe life threatening parosmia even if resultant anosmia.
Tomokatsu Hori has graduated from Tokyo University Faculty of Medicine in 1968. He was Research Fellow at Sainte Anne Hospital (Professor J Talairach) from 1973-1975. He held several positions such as Associate Professor, Department of Neurosurgery, Tottori University (1981); Professor, Department of Neurosurgery, Tottori University (1984);ãChairman and Professor, Department of Neurosurgery, Tokyo Women’s Medical University (1998); Emeritus Professor of Tokyo Women’s Medical University (2009); President of Tokyo Neurological Center Hospital (2016).