gms | German Medical Science

Objective: The last decades have shown that microsurgical treatment of pituitary lesions using the transsphenoidal approach is a safe and effective. During the last years many reports on endoscopic pituitary surgery have been published, uniformly claiming that nasal complications are rare compared to microsurgery. However, no data on ENT investigations have been released so far. Therefore, we present the ENT-data of our consecutive series of microsurgical pituitary operations.

Method: A physical examination of patients with a pituitary lesion who were operated upon neurosurgically was conducted by one ENT specialist since 03. In a prospective study, 68 patients (32 female, 36 male) underwent evaluation of nasal morphology, a standardized smell test (Sniffin'sticks, X of 12) for jugdement of olfactory function, and nasal breathing function using rhinomanometry preoperatively and postoperatively after 3-5 days (no rhinomanometry), as well as after 3-4 months.

Results: Morphological changes, especially a perforation of the nasal septum or of the outer nose due to the current surgery have not been observed. A secondary septoplasty had to be performed in one patient (1.5%) with increasing nose-breathing obstruction. Three patients (4.4%) with nasal breathing disability underwent a laser surgical transection of mucosal synechia. Directly after surgery, a reduction in smell function was detected in almost all patients as expected. In the control at 3 months this impairment resolved in all cases but one. Moreover, in 6 patients (8,8%) an improvement of nose breathing ability compared to the preoperative state was found. An improvement of smell function in 2 patients (3%) with preoperative anosmia (> 6 sniffin'sticks) was observed. None of the patients had an enrolment of olfactory disorder. The results of the nine month follow-up are yet pending.

Conclusions: Microsurgical resection of pituitary tumors via the direct transnasal transsphenoidal approach has an acceptable risk for nasal complications. The incidence of secondary rhinosurgical intervention is low (5.9%).