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KMID : 1037420190140010028
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Journal of Korean Skull Base Society
2019 Volume.14 No. 1 p.28 ~ p.33
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Clinical outcomes of transsphenoidal approach for pituitary adenomas following rhinosinusitis surgery
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Kim Dong-Sup
Park Chan-Soon
Kim Young-Il
Kim Il-Sup
Sung Jae-Hoon
Yang Seung-Ho
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Abstract
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Background: Transsphenoidal surgery (TSS) is the mainstay of treatment for sellar and parasellar lesions. Nasal and paranasal sinus inflammation is considered a contraindication to TSS because of possible transcranial spread of infection. The objective of this study was to determine outcomes of TSS after operations for rhinosinusitis.
Methods: Medical records and radiological findings of 8 consecutive patients who underwent TSS for pituitary adenomas following operations for rhinosinusitis were reviewed.
Results: These patients consisted of 2 men and 6 women, with a mean age of 56.8 years (range, 34-74 years). Their presenting symptoms were visual defect (4 patients) and headache (4 patients) from neurosurgeon’s aspect. Rhinology examination revealed a preoperative Lund-Mackay score of 1 to 6 with involvement of sphenoid and ethmoid sinuses in 8 and 4 patients, respectively. Fungal infection was confirmed in 3 patients intraoperatively. The median interval between rhinosinusitis surgery and TSS was 55.8 days (range, 7-155 days). The median duration of antibiotics administration was 32.9 days (range, 9-84 days) after the rhinosinusitis surgery. Intraoperative tearing of suprasellar cistern and cerebrospinal fluid (CSF) leakage occurred in 5 patients during TSS for pituitary adenomas. Postoperative meningitis was noted in 2 patients and treated with further antibiotics administration.
Conclusions: It is important to treat rhinosinusitis issues preoperatively for TSS. Intraoperative CSF leakage could increase the risk of postoperative meningitis in patients with rhinosinusitis even though it has been treated surgically and medically. Collaboration between rhinologist and neurosurgeon is mandatory for patients’ safety.
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KEYWORD
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Transsphenoidal approach, Pituitary adenoma, Rhinosinusitis, Endoscopic sinus surgery, Complication
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