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.
Key words
pituitary surgery - sinonasal outcome - nasal synechia - hyposmia - quality of life
