Quality of Life after Endoscopic Transsphenoidal Pituitary Surgery: Rhinological Outcome Evaluation

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 evaluation we review our 10 year experience with fully endoscopic pituitary surgery regarding the rhinological outcome.

Methods: Between 2004 and 2012, a total of 321 patients were treated via mono- or binostril transsphenoidal fully endoscopic approaches. 38 patients were excluded from the evaluation because of other histology 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%) underwent previous pituitary surgery.

Results: Fifty-two patients (18.4%) had a micro-adenoma, 227 (80.2%) a macro-adenoma, and 4 (1.4%) a giant adenoma. Intrasellar tumor growth only was present in 27.9%, intra- and suprasellar 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 those one case had a pervious surgery of the paranasal sinus. Cause of epistaxis in all cases was opening of the sphenopalatine artery. It was dissolved by nasal packing in six 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 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 vital mucosa, restrictive use of bipolar coagulation and preserving of the sphenopalatine artery.

Conclusion: 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 quality of life. Currently a prospective study on the rhinological function and outcome is recruiting in our department.