Abstract
Background The return of olfaction and of sinonasal function are important end points after
pituitary surgery. Opinions differ on the impact of surgery because techniques vary
greatly. A modified preservation of the so-called olfactory strip is described that
utilizes a small nasoseptal flap and wide exposure.
Methods A cohort of patients undergoing pituitary surgery and endoscopic sinonasal tumor
surgery were assessed. Patient-reported outcomes (Sino-Nasal Outcome Test [SNOT22]
and Nasal Symptom Score [NSS]) were recorded. A global score of sinonasal function
and the impact on smell and taste were obtained. Objective smell discrimination testing
was performed in the pituitary group with the Smell Identification Test. Outcomes
were assessed at baseline and at 6 months.
Results Ninety-eight patients, n = 40 pituitary (50.95 ± 15.31 years; 47.5% female) and n = 58 tumor (52.35 ± 18.51 years; 52.5% female) were assessed. For pituitary patients,
NSSs were not significantly different pre- and postsurgery (2.75 ± 3.40 versus 3.05 ± 3.03;
p = 0.53). SNOT22 scores improved postsurgery (1.02 ± 0.80 versus 0.83 ± 0.70; p = 0.046). Objective smell discrimination scores between baseline and 6 months were
similar (31.63 ± 3.49 versus 31.35 ± 4.61; p = 0.68). No difference in change of olfaction was seen compared with controls (Kendall
tau-b p = 0.46).
Conclusions Preservation of the olfactory strip can provide a low morbidity approach without
adversely affecting olfaction and maintaining reconstruction options.
Keywords
smell - olfaction - nasoseptal - endoscopic - endonasal - pituitary
