Risk Factors for Rhinosinusitis After Endoscopic Transsphenoidal Adenomectomy

Abstract

Objective Patients undergoing endoscopic transsphenoidal adenomectomy (eTSA) for pituitary tumors are at risk for postoperative complications, including rhinosinusitis. We aimed to determine if preoperative sinonasal disease is a risk factor for postoperative rhinosinusitis (PRS). Study Design Retrospective review. Setting Tertiary academic center in U.S. Subjects and Methods Patients with a diagnosis of pituitary adenoma who underwent eTSA between 2007-2016. PRS patients were matched to non-PRS patients or sex, age, tumor size, skull base reconstruction with intranasal tissue grafting, and concurrent septoplasty. Groups were statistically analyzed for potential preoperative risk factors of sinonasal disease (patient-reported, radiographic, endoscopic). Results 49 of 987 patients who underwent eTSA developed PRS (44.9% male, 71.4% Caucasian, mean age 49.3y). On analysis of individual risk factors, there was a significantly higher proportion of patients with a history of prior sinonasal surgery in the PRS group than the non-PRS group (25.5% vs. 6.5%, p = 0.01); however, this group difference became insignificant on multivariate analysis. There were no significant group differences with regard to history of sinus infections, nasal symptoms, seasonal allergies, radiographic abnormalities, or sinonasal disease on endoscopy. Conclusion This is the first study to investigate preoperative sinonasal disease as a risk factor for PRS after eTSA. The risk factors considered did not demonstrate definitive risk for PRS, although a history of prior sinonasal surgery should be investigated further.

MCM7 as a marker of postsurgical progression in non-functioning pituitary adenomas

“…Interestingly, a recent study reported that prior sinonasal surgery might be associated with an increased risk of developing postoperative rhinosinusitis. Of notice, this was only significant in univariate and not in multivariable analyses 150 .…”

“…Reported postoperative nasal symptoms include rhinosinusitis, olfactory impairment, synechia, septal perforations, epistaxis, nasal congestion, and an unpleasant nasal smell [144][145][146][147][148][149][150] . In many studies, decreased sinonasal quality of life is seen mostly during the first weeks after surgery and then approaches baseline levels after 3-6 months [147][148][149][151][152][153] .…”

Olfaction and Beyond: Advancing Our Understanding for Evidence-Based Practice

“…In a study investigating risk factors for postoperative rhinosinusitis (PRS) after transsphenoidal adenohypophysectomy (TSA), Lee et al 8 posited preoperative sinonasal disease may portend higher risk for PRS. In a retrospective review and analysis of 987 patients, 49 developed PRS.…”