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

Abstract

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.

Impact of Concurrent Chronic Rhinosinusitis on Complication Rates after Endonasal Endoscopic Skull Base Surgery: A Single-Center Experience

“…Several authors preferred simultaneous surgeries for skull base lesions and CRS. 16 20 23 Results showed no changes in the outcome and complication rate after sinus surgery in addition to skull base surgery. In a review of 35 cases involving concurrent CRS and skull base lesions, only two patients required sinus surgical revision due to persistent CRS.…”

“…Some authors have recommended 2-week treatment with antibiotics. 16 The main concerns regarding the preoperative medical treatment of concurrent CRS are optimizing the intraoperative surgical field and preventing postoperative infection, mainly meningitis. All our patients underwent surgery without preoperative antibiotics.…”

“…Results showed that the prevalence of CRS among patients undergoing ESBS was higher in this study (24%) than in others (8%). 16 17 The high CRS rate might be correlated to the study type and inclusion criteria. However, further studies must be conducted to confirm this result.…”