Perioperative nasal and paranasal sinus considerations in transsphenoidal surgery for pituitary disease

Abstract

Endoscopic endonasal skull base surgery has emerged as the treatment modality of choice for a range of skull base lesions, particularly pituitary adenomas. However, navigation and manipulation of the nasal corridor and paranasal sinuses requires that surgeons are aware of effective techniques to maximize patient outcomes and avoid sinonasal morbidity postoperatively. This paper is a narrative review aimed to provide an updated and consolidated report on the perioperative management of the nasal corridor and paranasal sinuses in the setting of endoscopic skull base surgery for pituitary disease. Anatomic variants and common surgical techniques are discussed. Post-operative complications are evaluated in detail. Understanding the structural implications of the endonasal approach to the sphenoid is crucial to optimization of the surgical outcomes. We propose guidelines for perioperative management of endoscopic endonasal skull base surgery for pituitary diseases. Standardized treatment algorithms can improve patient satisfaction, and increase the comparability and the quality of reported information across research studies.

Single-institution case series of pituitary biopsy for suspected germinoma in the pediatric population: diagnostic utility, operative risks, and biopsy approaches

“…Open craniotomy was performed through a standard pterional craniotomy and subfrontal approach for stalk biopsy. Endoscopic endonasal biopsy was performed via standard transphenoidal approach to the sella for sampling of the pituitary gland 15 . Briefly, using Mayfield pin fixation, the patient was positioned supine with slight rightward head turn, care taken to avoid venous compression and therefore maintained in neutral to slight extension.…”

Remission, complications, and overall survival in transsphenoidal pituitary surgery—a Swedish single-center experience of 578 patients

“…However, a number of publications have focused on PROMs including disease-specific quality of life instruments, relating to rhinosinusitis [2, 7, 13-15, 33, 36]. It seems that a major patient complaint, after pituitary surgery, is due to sinonasal morbidity, something that needs to be taken into account, when planning patients for surgery [2,7,33,37,40].…”

Use of balloon-assisted nasal access to augment endoscopic endonasal transsphenoidal approach: illustrative case

“…10 Risks associated with this technique include compromise of mucosal vascular supply with resultant septal ischemia/perforation and small chance of visible external deformity following surgery. 5 , 10 Provision of nasal access using a balloon has been approved by the Food and Drug Administration (FDA)since April 2019 and may afford additional advantages from this perspective. The balloon and inflation device are not reusable.…”

“…With the development of lighted retractors and increasing popularity of endoscopic visualization, the endoscopic endonasal approach (EEA) through the sphenoid sinus has become mainstay of surgical access to pituitary lesions. [3][4][5] This approach affords a minimally invasive technique with wide angles of visualization and more degrees of freedom for the surgeon. Volumetric cadaveric studies show greatest degrees of surgical maneuverability with the binostril endoscopic approach in multiple dimensions when compared to microscopic sublabial, endonasal, and mononostril endoscopic approaches.…”