Rhinological Consequences of Microsurgical Endonasal-Transsphenoidal Surgery for Pituitary Tumors

Abstract

Background Transsphenoidal surgery for sellar lesions may affect patency and function of the nasal airways, smell and sinonasal quality of life. Below is our report on otorhinolaryngological data garnered from patients undergoing endonasal transsphenoidal pituitary microsurgery. Methods In a prospective study, 68 patients scheduled for transsphenoidal operations (32 female, 36 male, age 17–72 years) underwent otorhinolaryngological evaluation of their nasal morphology, a standardized smell test (sniffin’ sticks) and rhinomanometry to analyse nasal breathing function preoperatively, 3–5 days postoperatively (without rhinomanometry), after 3–4 months and after 9 months. Results Immediately after surgery, a reduction in smell sensation was detected in almost all patients. Within 3 months, this impairment resolved in all cases except one. In 2 patients (3%) with preoperative anosmia, improvement of smell function to>6 out of 12 sniffin’ sticks was observed. At final visit no patient was noted to have new anosmia. Within 3 months, the results of the rhinomanometry revealed that all patients except one, regained their preoperative nasal breathing function. In 6 patients (8.8%) an improvement in their nose breathing abilities compared to the preoperative state was found. Three patients (4.4%) underwent a LASER transection of mucosal synechiae. In one case with persistent nasal obstruction (1.5%), secondary septoplasty had to be performed. There was no case in which perforation of the nasal septum, nasal tip deflection, or saddle nose deformity was observed. Conclusion Microsurgical resection of pituitary tumors via the endonasal transsphenoidal approach poses an acceptable risk with regards to sinonasal complications. The incidence of secondary rhinosurgical interventions is low. Standardized comparative studies between endoscopic and microsurgical transsphenoidal operations should be undertaken.

Effects of Staged Nursing Care on Neuroendoscopic Transsphenoidal Pituitary Adenoma Resection and Postoperative Complications

“…e methods of "different nursing for the same disease" and "same nursing for different diseases" are adopted to carry out syndrome-differentiated nursing from the aspects of daily life, diet, emotion, medication, and nursing [23]. Despite the fact that routine nursing interventions such as diet and psychology are included in the routine nursing of neuroendoscopic transsphenoidal pituitary tumor resection, the effect of routine nursing is relatively low due to the insufficient understanding of the time when the patient requires nursing [24].…”

Chemosensory dysfunction in Cushing’s syndrome

“…Patients with CD showed slightly better scores than CPA patients at 3 months of follow-up. Since all patients with CD underwent endonasal-transsphenoidal surgery, the surgical procedure appears to have no adverse effect on smell and taste [ 36 ], but a longer follow-up might elucidate this further.…”

Pituitary in the Spotlight

“…This special issue contains -besides the guideline -12 articles, split into review articles and original studies. It starts with a review on the clinical implications of the new WHO classification of pituitary tumors [12], followed by manuscripts addressing the rhinological consequences of pituitary surgery [13] and the outcome of transsphenoidal surgery in prolactinomas [14], and a review article covering recent advances in craniopharyngioma [15]. An original study reports 3 cases of aggressive pituitary tumors treated by bevacizumab [16] and a more general review addresses medical options in these tumors [17].…”