Fast-track surgery strategy for microscopic resection of pituitary adenomas using a single-nostril transsphenoidal approach

Abstract

Objective To explore the fast-track surgery (FTS) strategy in microscopic resection of pituitary adenomas using a single-nostril transsphenoidal approach. Methods The clinical data of 88 patients with pituitary adenomas, admitted to and underwent microscopic surgery using a transsphenoidal approach in our hospital from June 2015 to December 2017, were retrospectively analyzed. Only one nostril was used during surgery through a transverse incision in the nasal septum; the middle turbinates and nasal septum were not resected, and only the anterior wall of the sphenoidal sinus was removed; fenestration of the mucosa at the sellar floor was conducted; no hemostatic material was used to fill the sphenoidal sinus cavity, and the sphenoidal sinus drainage tube was retained. Four months after surgery, the modified Chinese version of 22-item Sino-nasal Outcome Test (SNOT-22) was used to evaluate the postoperative nasal complications and quality of life of the patients. The experiences with FTS strategy through microscopic resection of pituitary adenomas using a single-nostril transsphenoidal approach were summarized. Results The complete tumor resection rate was 65.90% (58/88), near total resection rate was 12.50% (11/88), subtotal resection rate was 19.32% (17/88), and partial resection rate was 2.27% (2/88). No such complications, as nasal septum perforation, delayed epistaxis, or internal carotid artery injury, were observed. Of the 88 patients, 32 were lost to follow-up; the 56 patients who reported for follow-up were evaluated in accordance with modified Chinese version of SNOT-22: 8 (14%) had a total scores>10; the mean highest and lowest scores for the various items were 0.02 (purulent nasal discharge) and 0.88 (hyposmia), respectively; most items had scores of 0-0.3. The postoperative discomfort experienced by the patients mainly included hyposmia, dizziness, head and facial pain or pressure, fatigue, and nasal congestion. Among the 56 patients, there were 26 with hyposmia, including 10 with mild hyposmia, 9 with moderate hyposmia and 7 with severe hyposmia. Conclusion Application of FTS reduces the incidence of nasal complications, and increases the postoperative comfort of patients in protecting the normal tissue structure in the nasal cavity for patients with pituitary adenomas. Key words: Pituitary adenoma; Rapid rehabilitation surgery; Comfort; Single-nostril transsphenoidal approach