Abstract
ObjectiveThe trans-sphenoidal approach is most frequently used for pituitary adenoma (PA) enucleation. However, effects of this surgery on neighboring structures have received little attention so far. In particular, no investigations on olfactory bulb (OB) anatomy after trans-sphenoidal surgery have been reported. Because impairment of olfaction has been shown in small groups following trans-sphenoidal surgery we hypothesized that the transnasal approach is likely to alter OB volume which is associated with changes of olfactory function.MethodsThe study comprised 33 patients with pituitary adenoma (14 women and 19 men, mean age 50 years). Comprehensive assessment of olfactory function was conducted with the "Sniffin' Sticks" test kit. Based on magnetic resonance imaging scans OBs were measured before and approximately one year after trans-sphenoidal PA enucleation.ResultsOwing to postoperative non-compliance and MRI artifacts partly due to drill friction complete evaluation of “Sniffin' Sticks” in term of obtaining the TDI score was possible pre- and postoperatively in 21 patients whereas OB volumes were available in 32 patients. Approximately one year after surgery olfactory function was not significantly different from baseline. However, left- and right-sided OB volume in patients treated via trans-sphenoidal surgery decreased (p = 0.001). The side of the surgical approach did not affect OB volume in a side-specific manner. Changes in odor threshold were significantly correlated to changes in right-sided OB volume (r = 0.45, p = 0.024).ConclusionOverall olfactory performance one year after surgery was not significantly different from baseline. However, changes in OB volume are associated with changes in olfactory performance and OB volumes decreased in patients.
Highlights
Transnasal trans-sphenoidal pituitary surgery is a common and well established approach for removing lesions from the sellar region with 10–15% of all brain tumors being related to this area [1]
Owing to postoperative non-compliance and MRI artifacts partly due to drill friction complete evaluation of “Sniffin’ Sticks” in term of obtaining the TDI score was possible pre- and postoperatively in 21 patients whereas olfactory bulb (OB) volumes were available in 32 patients
Left- and right-sided OB volume in patients treated via trans-sphenoidal surgery decreased (p = 0.001)
Summary
Transnasal trans-sphenoidal pituitary surgery is a common and well established approach for removing lesions from the sellar region with 10–15% of all brain tumors being related to this area [1]. Main goals are total enucleation of the tumor, preservation of the olfactory neuroepithelium, care of neuroendocrine and visual structures [2]. Impairment of olfactory function after trans-sphenoidal surgery has been described [12,13,14]. There have been no investigations comparing the olfactory bulb (OB) volume after trans-sphenoidal surgery in patients with pituitary mass lesions. The primary objective of our study was to evaluate OB volume in patients undergoing transnasal trans-sphenoidal surgery for pituitary adenoma (PA). Considering the neuroplasticity of the OB [15] and its response to changes in olfactory sensitivity we expected a volumetric change in this neuroanatomic structure
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