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Chronic nasal complication following endoscopic and microscopic direct transnasal transsphenoidal pituitary adenoma surgery

Abstract

Aim and background

Intranasal transsphenoidal access to the sella turcica for removing pituitary gland tumors has been known since the beginning of the last century. It can be done either endoscopic or microscopic. Postoperative nasal complications may happen. The purpose of this study was to assess the frequency of chronic oronasal alterations.

Methodology

33 patients who had previously undergone adenomectomy with a hypophyseal transsphenoidal approach using either the endoscopic or the direct transnasal microscopic technique; these patients were operated in different neurosurgical units. Assessement of nasal complications after 6 months was done.

Results

33 patients among them 18 patients were done by endoscopy and the other 15 were done by microscopy. No postoperative nasal complications in the endoscopy group 6 months postoperative while it is present in 3 cases of the microscopic group after the same time.

Conclusion

Direct transnasal approach provides safe transsphenoidal access to the sella with a very low rate of nasal complications.

References

  1. 1

    Hardy J. Transsphenoidal hypophysectomy. J Neurosurg 1971; 34:582–594.

    CAS  Article  Google Scholar 

  2. 2

    Hardy J. Surgery of the pituitary gland, using the open trans-sphenoidal approach. Comparative study of 2 technical methods. Ann Chir 1967; 21:1011–1022.

    CAS  PubMed  Google Scholar 

  3. 3

    Monnier DS. Endonasal sequelae after hypophysectomy. Ann Otolaryngol Chir Cervicofac. 1998; 115:49–53

    PubMed  Google Scholar 

  4. 4

    Petry C, Leães CG, Pereira-Lima JF, Gerhardt KD, Sant GD, Oliveria Mda C. Oronasal complications in patients after transsphenoidal hypophyseal surgery. Braz J Otorhinolaryngol 2009; 75:345–349.

    PubMed  Google Scholar 

  5. 5

    Tabaee A, Anand VK, Barrón Y, Hiltzik DH, Brown SM, Kacker A, et al. Endoscopic pituitary surgery: a systematic review and meta-analysis. J Neurosurg 2009; 111:545–554.

    Article  Google Scholar 

  6. 6

    Schaberg MR, Anand VK, Schwartz TH, Cobb W. Microscopic versus endoscopic transnasal pituitary surgery. Curr Opin Otolaryngol Head Neck Surg 2010; 18:8–14.

    Article  Google Scholar 

  7. 7

    Nasseri SS, Kasperbauer JL, Strome SE, McCaffrey TV, Atkinson JL, Meyer FB. Endoscopic transnasal pituitary surgery: report on 180 cases. Am J Rhinol 2001; 15:281–287.

    CAS  Article  Google Scholar 

  8. 8

    Sharma K, Tyagi I, Banerjee D, Chhabra DK, Kaur A, Taneja HK. Rhinological complications of sublabial transseptal transsphenoidal surgery for sellar and suprasellar lesions: prevention and management. Neurosurg Rev 1996; 19:163–167.

    CAS  Article  Google Scholar 

  9. 9

    Eisele DW, Flint PW, Janas JD, Kelly WA, Weymuller EA Jr, Cummings CW. The sublabial transseptal transsphenoidal approach to sellar and parasellar lesions. Laryngoscope 1988; 98:1301–1308.

    CAS  Article  Google Scholar 

  10. 10

    Griffith HB, Veerapen R. A direct transnasal approach to the sphenoid sinus. Technical note. J Neurosurg 1987; 66:140–142.

    CAS  Article  Google Scholar 

  11. 11

    Cooke RS, Jones RA. Experience with the direct transnasal transsphenoidal approach to the pituitary fossa. Br J Neurosurg 1994; 8:193–196.

    CAS  Article  Google Scholar 

  12. 12

    Tan LK, Jones RA. Nasal complications of the direct transnasal approach to the pituitary fossa. Br J Neurosurg 1995; 9:739–742.

    CAS  Article  Google Scholar 

  13. 13

    Kennedy DW, Cohn ES, Papel ID, Holliday MJ. Transsphenoidal approach to the sella: the Johns Hopkins experience. Laryngoscope 1984;94:1066–1074.

    CAS  Article  Google Scholar 

  14. 14

    Mampalam TJ, Tyrell JB, Wilson CB. Transsphenoidal microsurgery for Cushing’s disease: a report of 216 cases. Ann Intern Med 1988; 109:487–493.

    CAS  Article  Google Scholar 

  15. 15

    Black PM, Zervas NT, Candia GL. Incidence and management of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery 1987; 20:920–924.

    CAS  Article  Google Scholar 

  16. 16

    Faria MA Jr, Tindall GT. Transsphenoidal microsurgery for prolactin-secreting pituitary adenomas. J Neurosurg 1982; 56:33–43.

    Article  Google Scholar 

  17. 17

    Riche H, Jaboulay JM, Chiara Y, Peloux A. Complications post-operatoires de la voie trans-sphenoidale. Minerva Anestesiol 1992; 58:71–72.

    CAS  PubMed  Google Scholar 

  18. 18

    Qu X, Yang J, Sun JD, et al. Transsphenoidal pseudocapsule-based extracapsular resection for pituitary adenomas. Acta Neurochir (Wien) 2011; 153:799–805.

    Article  Google Scholar 

  19. 19

    Liu JK, Orlandi RR, Apfelbaum RI, Couldwell WT. Novel closure technique for the endonasal transsphenoidal approach. Technical note. J Neurosurg 2004; 100:161–164.

    Article  Google Scholar 

  20. 20

    Hardy J, McCutcheon IE. Pituitary adenomas: pituitary macroadenomas. In: Apuzzo MLJ editor. Brain surgery: complication avoidance and management. New York, NY: Churchill Livingstone; 1993:276–295.

    Google Scholar 

  21. 21

    Hardy J, Vezina JL. Transsphenoidal neurosurgery of intracranial neoplasm. New York, NY: Raven Press 1976:261–275

    Google Scholar 

  22. 22

    Laws ER Jr, Kern EB. Complications of transsphenoidal surgery. Clin Neurosurg 1976; 23:401–416.

    Article  Google Scholar 

  23. 23

    Laws ER Jr. Transsphenoidal approach to lesions in and about the sellaturcica. In: Schmidek HH, Sweet WH, editors. Operative neurosurgical techniques: indications, methods, and results. Philadelphia, PA: W.B. Saunders Co. 1988:309–319

    Google Scholar 

  24. 24

    Doty RL. Olfaction. Annu Rev Psychol 2001; 52:423–452.

    CAS  Article  Google Scholar 

  25. 25

    Kahilogullari G, Beton S, Al-Beyati ES, Kantarcioglu O, Bozkurt M, Kantarcioglu E, et al. Olfactory functions after transsphenoidal pituitary surgery: endoscopic versus microscopic approach. Laryngoscope 2013; 123:2112–2119.

    Article  Google Scholar 

  26. 26

    Wang S, Chen Y, Li J, Wei L, Wang R. Olfactory function and quality of life following microscopic endonasal transsphenoidal pituitary surgery. Medicine (Baltimore) 2015; 94:e465.

    Article  Google Scholar 

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Correspondence to Hisham Lasheen.

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Lasheen, H., Youssef, O. Chronic nasal complication following endoscopic and microscopic direct transnasal transsphenoidal pituitary adenoma surgery. Egypt J Otolaryngol 33, 20–23 (2017). https://doi.org/10.4103/1012-5574.199412

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Keywords

  • chronic
  • complication
  • endoscopic
  • microscopic
  • nasal
  • pituitary
  • surgery
  • transsphenoidal