Clinical Significance of Nasal Pathologies in Transnasal Transsphenoidal Pituitary Surgery

Abstract

We evaluated the frequency of nasal pathologies and the significance of surgical access to the sellar region in patients who underwent an operation for sellar mass using the endonasal and microscopic transsphenoidal approaches. We retrospectively evaluated all patients who underwent surgery for pituitary macroadenoma using microscopic (n=78) and endonasal (n=20) transsphenoidal approaches. Patients' epicrisis, preoperative, and postoperative imaging as well as their operative notes were reviewed. Nasal pathologies and surgeries performed before or during the pituitary surgery were also documented. All endonasal surgeries were binostril and performed jointly by an ear, nose, and throat specialist and neurosurgeon. To determine the feasibility of endonasal and microscopic approaches, we developed an algorithm using the septum deviation classifications to determine the need for septoplasty. The most common nasal pathology was septum deviation (n=17; 17.3%). Of the other nasal pathologies, 6 cases (6%) were chronic sinusitis and 2 were (2.1%) middle turbinate bullosa. The preoperative evaluation of patients undergoing endonasal transsphenoidal surgery by an ear, nose, and throat surgeon allows for the detection and treatment of nasal pathologies that may lead to serious perioperative and postoperative complications. Evaluating patients with septum deviation using our classification will help determine the necessity of preoperative or perioperative septum surgery, depending on the preferred pituitary surgical method.