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J Neurol Surg B Skull Base 2024; 85(05): 489-500
DOI: 10.1055/a-2158-6162
Original Article

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

Ethical Approval

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




Publication History

Received: 26 April 2023

Accepted: 17 August 2023

Accepted Manuscript online:
22 August 2023

Article published online:
25 September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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