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J Neurol Surg B Skull Base
DOI: 10.1055/a-2158-6162
Invited Review

Comparison of Sinonasal Outcomes in Patients Undergoing Uni-nostril and Bi-nostril Endoscopic Trans-sphenoidal Excision of Pituitary Adenomas: A Prospective Study

Hemanth Vupputuri
1   Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
,
Wilson Prashanth D'Souza 
1   Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
,
Zoremsangi Ralte
2   Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamil Nadu, India
,
Vikram Malleshappa
2   Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamil Nadu, India
,
Ari George Chacko
1   Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
,
Vedantam Rupa
2   Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamil Nadu, India
,
Vedantam Rajshekhar 
1   Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract

Background Prospective studies comparing quality-of-life and olfaction in patients undergoing endoscopic uni-nostril versus bi-nostril trans-sphenoidal pituitary surgery have not been published.

Methods We prospectively compared olfaction and quality-of-life at baseline and at 3 to 6 months follow-up using the Anterior Skull Base Nasal Inventory-12 (ASK-12) questionnaire, composite olfaction score, and Lund–Kennedy Endoscopic Score (LKES) in 43 patients who underwent endoscopic excision of pituitary adenoma with either a uni-nostril (24 patients) or a bi-nostril (19 patients) approach.

Results Baseline data for both groups were comparable. In the uni-nostril group, ASK-12 and LKES scores were not significantly different at follow-up when compared with the preoperative scores. In the bi-nostril group, there was a significant postoperative worsening of ASK-12 scores (mean: 3.2 vs. 5.3; p = 0.04) and the LKES (mean: 2.9 vs. 6.6; p = 0.01). Composite olfaction score was not significantly affected postoperatively with either approach. Nasal complications were also more in the bi-nostril group (5/18, 27.8% vs. 1/23, 4.3%) but this was not statistically significant (p = 0.07).

Conclusion Both approaches preserve olfactory function but the uni-nostril approach is associated with better postoperative quality-of-life and endoscopic scores and subjective olfaction outcomes. At least in short term, the postoperative morbidity is higher in the bi-nostril approach compared with the uni-nostril approach. Although preference for a particular approach is related to a surgeon's preference, preoperative counselling of the patients regarding sinonasal morbidity is important.

Keywords

endoscopic surgery - olfaction - quality of life - trans-sphenoidal surgery

Institutional Review Board Approval

We obtained approval from the institutional review board and ethics committee of the institution for the conduct of this study (IRB number 11113).




Publikationsverlauf

Eingereicht: 26. April 2023

Angenommen: 17. August 2023

Accepted Manuscript online:
22. August 2023

Artikel online veröffentlicht:
25. September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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