Equivalent outcomes in nasal symptoms following microscopic or endoscopic transsphenoidal surgery: results from multi-centre, prospective study

Abstract

Background T ranssphenoidal surgery (TSS) is the standard approach for resection of pituitary lesions. Historically, this has utilized the microscopic approach (mTSS); however, the past decade has seen widespread uptake of the endoscopic approach (eTSS). The purported benefits of this include improved visualization and illumination, resulting in improved surgical and endocrinological patient outcomes. It is also believed that eTSS results in fewer post-operative nasal symptoms compared to mTSS; however, few papers have directly compared these groups. Objectives We sought to compare nasal symptoms after endoscopic uninostril (eTSS-uni), endoscopic binostril (eTSS-bi) and microscopic endoscopic transsphenoidal surgery (mTSS). Methods The General Nasal Patient Inventory (GNPI) was prospectively administered to 136 patients (71 non-functioning adenomas, 26 functioning adenomas, 39 other pathology) undergoing transsphenoidal surgery at multiple time points (pre-operatively; days 1, 3 and 7–14; months 1, 3 and 6 and 1 year post-operatively). All surgeries were performed by subspecialist pituitary surgeons in three subgroups — mTSS (25), eTSS-uni (74) and eTSS-bi (37). The total GNPI scores (0–135) and subscores for the 45 individual components were compared across three groups assessing for temporal and absolute changes. Results Irrespective of surgical approach used, GNPI scores were significantly higher on post-operative day 1 (p < 0.001) and day 3 (p ≤ 0.03) compared to pre-treatment baseline (mixed-effects model). By 1 month post-operatively, however, post-operative GNPI scores were no different from pre-treatment (p > 0.05, mixed-effects model). Whilst the eTSS-uni group demonstrated significantly lower GNPI scores at day 1 post-op compared to the mTSS group (p = 0.05) and eTSS-bi group (p < 0.001), there was no significant difference in post-operative scores between approaches beyond 1–2 weeks post-operatively. Similar results were obtained when the non-functioning tumour group was analysed separately. Conclusions Transsphenoidal pituitary surgery is well tolerated. Post-operative nasal symptoms transiently worsen but ultimately improve compared to pre-operative baseline. Operative approach (microscopic, endoscopic uninostril or endoscopic binostril) only has a transient effect on severity of post-operative nasal symptoms.

Olfactory and gustatory outcomes following endoscopic transsphenoidal hypophysectomy

“…In a recent study by Charlie et al [ 27 ], the General Nasal Patient Inventory (GNPI) was prospectively administered to 136 patients. The GNPI is a sensitive tool used in evaluating pre- and postoperative nasal symptoms after nasal surgery.…”

“…A sinonasal quality of life was evaluated using the Sinonasal Outcome Test-22 (SNOT-22) questionnaire used to measure the sinonasal outcome. It was concluded there was no significant difference in QOL between scores before and 6 months after surgery [ 27 ].…”

Characteristics of inflammatory and infectious diseases of the pituitary gland in patients undergoing transsphenoidal surgery

“…Recently, the field has seen a shift from microsurgical to endoscopic TSS [ 16 ]. Both techniques are considered equally successful and are associated with low perioperative risk when performed in experienced centers [ 1 , 17 – 19 ]. We almost exclusively operate microsurgically, and we have found the routine use of intraoperative MRI exceedingly valuable, resulting in high rates of complete tumor removal at the primary surgery [ 20 ].…”

Sinonasal Outcome After Endoscopic Transnasal Surgery—A Prospective Rhinological Study

“…In a multicenter prospective study from Osborne et al, 39 nasal symptoms transiently worsen after surgery with no significant difference in scores (General Nasal Patient Inventory) between microscopic, endoscopic uninostril and binostril approach.…”