Comparing Sinonasal Outcomes between Functional and Nonfunctional Pituitary Lesions after Endoscopic Sellar and Parasellar Surgery

Background: Pituitary tumors can be divided into functional and nonfunctional lesions. The systemic effects of pituitary hormones are well-known but local effects in the sinonasal region are not well characterized. We aimed to examine the difference in sinonasal outcomes between functional and nonfunctional pituitary lesions after endoscopic surgical resection.

Methods: We performed a retrospective review of 304 patients presenting to a tertiary skull base center between 2014 and 2019, with a pituitary lesion who received endoscopic sellar or parasellar surgical resection. This population was then divided into nonfunctional and functional groups. We examined both surgical outcomes, as well as pre- and postoperative quality of life scores between the two groups.

Results: High cortisol and GH levels were associated with significant preoperative nasal findings (p < 0.05). Preoperative total SNOT 22 scores were not different between the two groups, but the rhinologic and extrarhinologic subdomain scores in the functional group was higher than in the nonfunctional group (3.57 ± 3.95 vs. 2.58 ± 3.64, and 1.48 ± 2.2 vs. 0.92 ± 1.75, respectively; p = 0.038 and 0.017). Postoperative SNOT 22 score improvement was significantly greater in the functional group at 6-weeks postoperation (6.75 ± 17.51 vs. 1.4 ± 16.83, respectively; p = 0.011). This was true in both rhinologic and extrarhinologic subdomain scores (4.79 ± 5.93 vs. 2.83 ± 5.98, and 1.74 ± 2.72 vs. 0.91 ± 2.87, respectively; p = 0.008 and 0.018). Time to complete normalization on nasal endoscopy was longer in the functional group compared with the nonfunctional group (p = 0.018).

Conclusion: Functional pituitary tumors are associated with preoperative sinonasal changes, particularly corticotropic and somatotropic tumors. These changes affect quality of life both pre- and postoperation, in both rhinologic and extrarhinologic subdomains of the SNOT-22. Patients with functional tumors took longer to reach full healing and normalization of the sinus cavity postoperatively.