Asymptomatic radiographic sinonasal inflammation does not affect pituitary surgery outcomes

Abstract

Objective: Chronic rhinosinusitis (CRS) is a proposed risk factor for meningitis and other intracranial complications following the endoscopic endonasal transsphenoidal approach (TSA). Some have recommended staging TSA following surgery for CRS; however, delaying TSA has important ramifications. The objective of this study is to determine whether asymptomatic sinonasal inflammation (RSNI) on preoperative computed tomography scans, without clinical CRS, is associated with postoperative complications following TSA.Methods: All consecutive TSA cases performed at a single tertiary care institution from January 1, 2009, to December 31, 2017, were reviewed for patient demographics, prior surgery, presence of RSNI on preoperative computed tomography scan based on Lund-Mackay (LM) score, intraoperative cerebrospinal fluid (CSF) leak, and postoperative complications (postoperative CSF leak, bleeding, infection). The association between preoperative RSNI and postoperative complications was analyzed via multivariate logistic regression.Results: One hundred seventy-one cases of TSA were included with mean patient age of 52.6 years, 42.7% males, 18.1% revision cases, and mean LM score of 1.9 AE 2.7. Complications were identified in 9.9% of patients at the following rates: 5.3% postoperative CSF leak, 2.9% bleeding, and 1.8% infection (all sinusitis, no episodes of meningitis). Neither total LM score nor LM score >5 (representative of clinically significant radiographic CRS) were predictors of any postoperative complication (both P > 0.05). Age, sex, revision status, intraoperative CSF leak, and total LM score were not independent predictors of any postoperative complication on multivariate analysis (all P > 0.05).Conclusion: In asymptomatic patients, radiographic evidence of sinonasal inflammation is not associated with increased risk of complications following TSA.

Validation of Simultaneous Endoscopic Sinus Surgery and Transsphenoidal Surgery in Patients with Chronic Rhinosinusitis and Pituitary Tumors

“…4,[18][19][20] Sphenoiditis was recently reported as a risk factor, although several studies have stated that RS is not related to postoperative CNS infection. 3,4,[20][21][22] Prophylactic management has been recommended before TS surgery, being classified as a clean-contaminated procedure due to the air-containing sphenoid sinus. 23) Schaberg, et al 18) reported that seven patients with preoperative sphenoiditis underwent concurrent ESS and endoscopic surgery of the anterior skull base; no postoperative intracranial complications were noted.…”

“…8) Thus, controlling RS before performing TS surgery was strongly recommended, but the delay to surgery resulted in further deterioration of neurologic condition, manifested in vision changes, headache, and abnormal endocrine function. 3,9) We previously reported the operative outcomes of concurrent treatment of pituitary adenoma and chronic RS; the work was preliminary in nature. Postoperatively, no increase in the extent of RS was seen.…”

“…2) Accordingly, the complications of TS surgery have decreased dramatically. 3,4) The prevalence of rhinosinusitis (RS) in adults is approximately 12% in the United States. 5) Bacterial acute RS is associated with potential complications including orbital infection, meningitis, and brain abscess.…”

Prevalence and Clinical Significance of Radiographic Sinus Disease on Preoperative Computed Tomography Imaging in the Endoscopic Skull Base Surgery Population

“…Management of patients with skull base pathology requiring operative intervention with concomitant chronic rhinosinusitis findings on imaging remains controversial. While some authors recommend addressing the sinonasal disease at the time of ESBS, [5][6][7][8] others have advised against this due to the risk of intracranial spread of infection, particularly in the presence of sphenoid sinus disease. [9][10][11][12][13] Encountering an unexpected active infection may also result in the need for same day cancellation of an ESBS, which can be very disruptive for the patient, the surgeon, and the health care system.…”

Risk Factors for Rhinosinusitis After Endoscopic Transsphenoidal Adenomectomy

“…A recent study found that preexisting asymptomatic radiographic sinonasal disease, assessed via Lund-Mackay score on computer tomography (CT), does not increase risk for postoperative complications including PRS. 9 The risk associated with preoperative endoscopic findings and patient-reported symptoms have yet to be explored.…”