Rate of rhinosinusitis and sinus surgery following a minimally destructive approach to endoscopic transsphenoidal hypophysectomy

Abstract

Background There remains considerable variation in the extent of sinonasal preservation during the approach for endoscopic transsphenoidal hypophysectomy (TSH). We advocate for a minimally destructive approach utilizing turbinate lateralization, small posterior septectomy, no ethmoidectomy, and preservation of nasoseptal flap (NSF) pedicles bilaterally. Due to these factors, this approach may affect the rates of postoperative rhinosinusitis. The objective of this study is to define the rates of postoperative rhinosinusitis in patients undergoing this approach. Methods Single institution, retrospective chart review of patients undergoing TSH from 2005 to 2018. Results A total of 415 patients were identified and 14% developed an episode of postoperative rhinosinusitis within 3 months. These patients were significantly more likely to have had a history of recurrent acute or chronic rhinosinusitis. Most cases were sphenoethmoidal sinusitis managed with 1 to 2 courses of antibiotics. Of patients with postoperative rhinosinusitis, most did not undergo NSF. Average follow‐up was 38 months. Six patients (1.4%) underwent post‐TSH functional endoscopic sinus surgery (FESS). Average time from TSH to FESS was 26.3 months. Two of these patients had a history of prior chronic rhinosinusitis without polyposis. Two patients underwent revision TSH for recurrent tumor as the primary indication for surgery at time of FESS. Twenty‐two–item Sino‐Nasal Outcome Test (SNOT‐22) scores generally increased immediately postoperatively, but frequently decreased below preoperative level by the time of last follow‐up, regardless of whether patients developed rhinosinusitis. Conclusion Sinonasal preservation during TSH is associated with a low rate of postoperative rhinosinusitis requiring FESS and excellent long‐term patient reported outcomes. We continue to advocate for sinonasal preservation during pituitary surgery.

Sinonasal Packing is Not a Requisite for Successful Cerebrospinal Fluid Leak Repair

“…Multiple studies have demonstrated initial increases in SNOT-22 at the first postoperative visit after endoscopic skull base surgery, followed by gradual improvements over time. [43][44][45] Of these studies, two utilized some form of nasal packing consistently, whereas one systematic review did not report frequency of nasal packing utilized. Taken with the findings from Little et al, which revealed decreased quality of life in the immediate postoperative period in association with nasal splints and packing.…”

Comparison of Sinonasal Outcomes in Patients Undergoing Uni-nostril and Bi-nostril Endoscopic Trans-sphenoidal Excision of Pituitary Adenomas: A Prospective Study

“…nasal mucosa with resultant crusting, nasal block, sinusitis and epistaxis occur. 14,[17][18][19][20] The two major endoscopic techniques in current practice are the uni-nostril and bi-nostril approaches, 3,6,10,21 both being safe and effective in pituitary surgery, although the bi-nostril approach may be preferred when an extended approach is required. 3,6,21 While the deterioration in QoL is probably transient, there are no prospective studies comparing the nasal outcomes between the two approaches.…”

“…Instruments that have been utilized for assessment of QoL following endoscopic pituitary surgery include Anterior Skull Base Nasal Inventory-12 (ASK Nasal-12), 22,41 SNOT 22, 14,[18][19][20]41 SNOT 20, 13 VAS, 13 SF-36, 42 and WHO-QoL BREF. 43 The ASK-12 is a site specific 12 question inventory which focuses on sinonasal morbidity and evaluates all likely This article is protected by copyright.…”

“…Many authors have shown that the sinonasal QoL worsens and reaches a nadir at 2-3 weeks following surgery followed by recovery by 6 weeks to 3 months. 14,17,20,41,46 (Table 6)…”

Opioid Use and Sinus Surgery

“…The authors suggest further in vivo studies to assess the impact of ROC on the full process of wound healing because the length of exposure was limited. Rimmer et al 9 . report a retrospective review of 415 patients who underwent endoscopic transsphenoidal hypophysectomy (TSH) via a “minimally destructive approach” (utilizing middle turbinate lateralization, small posterior septectomy without ethmoidectomy, and preservation of the nasoseptal flap) to determine the rate of postoperative rhinosinusitis.…”