gms | German Medical Science

Objective: The transsphenoidal transnasal route to pituitary adenomas is the preferred surgical corridor for theses tumors whenever feasible. Lately, endoscopic procedures gain more acceptance in the treatment of these tumor entity. Long-term consequences of the endonasal access path have rarely been investigated. Purpose of this prospective study is to assess patients' sinonasal symptoms and quality of life following transsphenoidal surgery of pituitary adenoma or skull base tumors.

Method: A total of 186 patients with pituitary adenomas or pathologies of the sellar region were operated between June 2011 and July 2014. To identify operation-related nasal complications patients were asked to assess a custom made inventory that was positively rated by the local ethic research committee. Pre- and postoperative usage of nose drops or nose spray, and scores of the nasal inventory which contains questions regarding frequency of nose bleeding, snoring, impaired nasal breathing, dry nose, crusting noses, impaired odor and impaired taste were assessed. As a standardized quality of life evaluation the short form-36 inventory (SF-36) was used and compared with reference values of german standard population.

Results: Of all patients operated during this period, 53 patients (28.5%) were available for study purposes and returned the allotted questionaire. We registered a mean age of 53.2 years (± 15.3). 28 men and 25 women (odds ratio 1.12:1) were included. 11 patients (20.8%) with preexisting allergies and 13 (24.5%) with prior nose surgery were identified. Mean nasal inventory score preoperative 4.2 (± 3.1) declined significant to 6.1 (± 3.5) postoperatively (p ≤ 0.001, Wilcoxon-test). 4 patients (7.5%) reported a regular use of decongestant topics, compared to 11 patients (20.8%) after the operation. Of 52 patients (1 missing value), 13 patients (25.0%) reported to suffer from persistent pain, with headache being the leading distress. At baseline our study group had poorer SF-36 values compared with the german standard population.

Conclusions: Even though the transsphenoidal route to the sellar region is commonly applied in pituitary surgery, quality of life and postoperative distresses are poorly investigated at present. With our data we show that despite an even successful operation concerning tumor resection patients suffer sequela of the operation even after years. It will be in the need of further studies to find possible ways to diminish this relatively high rate of nasal distress.