Surgical management of rhinosinusitis in endoscopic‐endonasal skull‐base surgery

Nyquist, Gurston; Friedel, Mark E.; Singhal, Saurabh; Beahm, D. David; Farrell, Christopher; Evans, James J.; Rosen, Marc

doi:10.1002/alr.21476

Cited by 18 publications

(22 citation statements)

References 19 publications

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“…They found that no patient developed any intracranial complications, including no postoperative CSF leaks or meningitis. The same group then expanded their series to 35 patients with dual diagnoses of skull base lesion and CRS, including patients with nasal polyposis and noninvasive fungal sinusitis, and once again found that no intracranial complications occurred in their cohort . Another case series of 11 patients by Heo and Park found that no intracranial complications were noted following concurrent TSA and endoscopic sinus surgery for sinusitis .…”

Section: Discussionmentioning

confidence: 96%

Asymptomatic radiographic sinonasal inflammation does not affect pituitary surgery outcomes

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 96%

Asymptomatic radiographic sinonasal inflammation does not affect pituitary surgery outcomes

et al. 2019

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“…Previously, in a case of sphenoiditis, we irrigated the opened sinuses with antibiotic-containing saline, 2) an approach that has since been abandoned. No patients had acute RS in our case series, but for patients with acute RS and pituitary le- [18][19][20]24) Subsequently, concurrent TS surgery with ESS can be performed, with minimal risk of postoperative cranial infection. 19,20) CSF leakage has also been reported in association with meningitis after TS surgery.…”

Section: Discussionmentioning

confidence: 80%

“…No patients had acute RS in our case series, but for patients with acute RS and pituitary le- [18][19][20]24) Subsequently, concurrent TS surgery with ESS can be performed, with minimal risk of postoperative cranial infection. 19,20) CSF leakage has also been reported in association with meningitis after TS surgery. 17,25) During TS surgery, CSF leakage occurs in up to 50% of patients.…”

Section: Discussionmentioning

confidence: 80%

“…Previous studies described three risk factors for meningitis following TS surgery. 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.…”

Section: Discussionmentioning

confidence: 99%

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

Park¹,

Park²,

Lee³

et al. 2020

Korean J Otorhinolaryngol-Head Neck Surg

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Background and Objectives Transsphenoidal (TS) surgery for removal of pituitary lesions has become popular with improvements in diagnostic and treatment modalities, as well as endonasal and endoscopic methods, resulting in reduced complications. Rhinosinusitis (RS) is considered a risk factor for postoperative intracranial infections. Previously, we showed that concurrent TS surgery and endoscopic sinus surgery (ESS) yielded a favorable outcome in cases with pituitary lesions and RS. However, there seems to be a lack of consensus in performing simultaneous TS and ESS for patients with a pituitary lesion and RS. We would like to validate the feasibility of performing two operations concurrently.Subjects and Method We reviewed the medical records of 13 patients who underwent simultaneous TS surgery and ESS between 2007 and 2016. One patient underwent concurrent TS surgery and ESS twice due to the regrowth of pituitary macroadenoma and recurrence of RS.Results There were only four minor nasal complications during the postoperative period, which were controlled with conservative treatment. Only one patient exhibited postoperative cerebrospinal fluid leakage and no patients experienced intracranial complications.Conclusion This study shows that it might be better to treat patients with pituitary lesion and RS simultaneously. Also, further studies with large cases would be necessary to manage these patients without intracranial complications.

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“…Typically, chronic rhinosinusitis does not represent an absolute contraindication to transsphenoidal surgery, however, patients with acute rhinosinusitis, especially those with fungal disease, should be treated appropriately prior to elective surgery. 11 Otolaryngology preoperative evaluation is critical in patients with acromegaly who frequently present challenges for airway management during surgery due to soft tissue hypertrophy and bony abnormalities. 12…”

Section: Principles Of Surgery Indications For Surgerymentioning

confidence: 99%

Principles of Pituitary Surgery

Farrell

Nyquist

Farag

et al. 2016

Otolaryngologic Clinics of North America

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Since the description of a transnasal approach for treatment of pituitary tumors, transsphenoidal surgery has undergone continuous development. Hirsch developed a lateral endonasal approach before simplifying it to a transseptal approach. Cushing approached pituitary tumors using a transsphenoidal approach but transitioned to the transcranial route. Transsphenoidal surgery was not "rediscovered" until Hardy introduced the surgical microscope. An endoscopic transsphenoidal approach for pituitary tumors has been reported and further advanced. We describe the principles of pituitary surgery including the key elements of surgical decision making and discuss the technical nuances distinguishing the endoscopic from the microscopic approach.

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Surgical management of rhinosinusitis in endoscopic‐endonasal skull‐base surgery

Cited by 18 publications

References 19 publications

Asymptomatic radiographic sinonasal inflammation does not affect pituitary surgery outcomes

Asymptomatic radiographic sinonasal inflammation does not affect pituitary surgery outcomes

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

Principles of Pituitary Surgery

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