gms | German Medical Science

Objective: Over the last century pituitary adenoma surgery has undergone a remarkable evolution in surgical technique, approaches and technological adjuncts. In our department the endoscopic approach was introduced as routine in 2004. Beside criteria such as tumor resection, ophthalmological and endocrinological outcome, the rhinological outcome is often neglected. In this retrospective study we review our 10 year experience with fully endoscopic pituitary surgery regarding the rhinological outcome.

Method: Between 2004 and 2012 321 patients were treated via mono- or binostril transsphenoidal fully endoscopic approaches. 38 patients were excluded from the evaluation because of a histology other than a pituitary adenoma. The rhinological outcome of 309 endoscopic procedures in 283 patients was evaluated. Mean age was 56 years (range 18-91). 43 patients (15,2%) had undergone previous pituitary surgery.

Results: 52 patients (18,4%) had a micro-, 227 (80,2%) a macro- and 4 (1,4%) a giant adenoma. Intrasellar tumor growth only was present in 27,9%, intra- and suprasellar growth in 56,9%, intra- and parasellar in 3,5% and intra- , supra- and parasellar in 11,7%. Complete endoscopic tumor resection was achieved in 83,6%. The most frequent intraoperative complication was CSF-leak in 18%. Postoperative epistaxis occurred in 10 cases (3,53%). Among these one case had had a previous surgery of the paranasal sinus. Cause of epistaxis in all cases was opening of the sphenopalatine artery. It was treated by nasal packing in 6 cases, endonasal coagulation in 2 cases und interventional angiographic embolization in 2 cases. Regarding the sense of smell, we recorded a transient hyposmia in 20 cases (7,07%), a permanent hyposmia in 7 cases (2,47%), a transient anosmia in 3 cases (1,06%) and a permanent anosmia in no case. Regarding the sense of smell, nasal airflow, crusting of the nasal mucosa and occurrence of synechia in the postoperative course, we postulate a significant relationship to sensitively dealing with the vital mucosa, restrictive use of bipolar coagulation and preserving of the sphenopalatine artery.

Conclusions: In endoscopic transnasal surgery, one should consider not only the tumor resection rate, the ophthalmological und endocrinological outcome but also the rhinological outcome. Limitations in rhinological function are accompanied by a significant deterioration in the quality of life. Currently a prospective study on the rhinological function and outcome is being organized in our department.