Improved nasal recovery and intact olfactory function after a transseptal approach for endoscopic endonasal transsphenoidal adenomectomy: A retrospective analysis

Abstract

Objectives: Endoscopic endonasal transsphenoidal adenomectomy (TSA) is the most frequently performed skull base surgery, and researchers have recently focused on preserving nasal function. The endoscopic transseptal approach is a promising procedure due to its reduced injury to the nasal mucosa; however, there are no studies comparing rhinological and neurosurgical outcomes concurrently with the standard endoscopic transnasal approach. Therefore, we conducted this study to investigate whether the transseptal approach could reduce nasal morbidities with comparable neurosurgical outcomes.Methods: We retrospectively reviewed 25 patients who underwent endoscopic endonasal transseptal TSA for pituitary adenoma without encasement of internal carotid artery from January 2019 to December 2020. Another 25 patients who received transnasal approach from January 2017 to December 2018 were selected as controls. Patients with diseases affecting the nasal cavity/olfaction or usage of a nasoseptal flap were excluded for a better comparison of the two procedures. We collected data from radiological studies, endocrine studies, endoscopic evaluations, 22-item sinonasal outcome tests (SNOT-22) and Top International Biotech SmellIdentification Test (TIBSIT) for comparison.Results: Lower postoperative SNOT-22 and Lund-Kennedy endoscopic scores were observed in the transseptal group. The effect size of differences were classified as large effect (The absolute value of Cohen's d > 0.8). Nevertheless, the TIBSIT scores were not significantly different. The rates of gross total resection, recovery of hormonal abnormalities, and complications were not significantly different. After controlling possible confounding factors using multivariate analysis, the endoscopic Yen-Hui Lee and Huan-Chih Wang are equal contributed.

Risk Factors for Development of Diabetes Insipidus and Syndrome of Inappropriate Antidiuretic Hormone Secretion after Transsphenoidal Resection of Pituitary Adenoma

“…approach for resection of these tumors but is not without its postoperative complications, [4][5][6][7][8][9][10] with two of the most common being transient diabetes insipidus (DI) and symptomatic hyponatremia, commonly as part of syndrome of inappropriate antidiuretic hormone release (SIADH). 11 These complications directly impact postoperative course and patient care, with previous studies documenting the rate of transient DI following transsphenoidal adenoma resection varying from 10 to 60%.…”

“…2 These tumors can grow to large sizes and subsequently cause clinical symptoms of visual field defects, headaches, hypopituitarism, and symptoms of excessive hormonal release depending on its histopathological makeup. 3 Endoscopic transsphenoidal hypophysectomy (TSH) has become the standard approach for resection of these tumors but is not without its postoperative complications, [4][5][6][7][8][9][10] with two of the most common being transient diabetes insipidus (DI) and symptomatic hyponatremia, commonly as part of syndrome of inappropriate antidiuretic hormone secretion (SIADH). 11 These complications directly impact postoperative course and patient care, with previous studies documenting the rate of transient DI following transsphenoidal adenoma resection varying from 10 to 60%.…”