Background and Objectives: Endoscopic transsphenoid approach (TSA) is the most common surgical approach to sella lesions providing a wider view via variable endoscopes and results in fewer neurosurgical side effects. However, the sinonasal complications are relatively less studied. This study aims to analyze sinonasal complications after endoscopic TSA performed by a single team of a center.
Methods: Among the 148 patients who underwent endoscopic TSA from April 2015 to April 2022, 107 patients who were followed up ≥ 3 months were included. All the operation was performed by one neurosurgeon and one rhinologist under navigation. Nasoseptal flap (NSF) was conducted in the cases of high flow CSF leak but lumber drain was not inserted. Postoperative endoscopic image was reviewed at point of 1st, 3rd, and 6th months. Olfactory function was compared with pre- and post-operatively using Korean version of sniffing sticks test (KVSS)-II. Surgical period was divided into first, second, and third period by the patient number (36/36/35) and sinonasal complications were compared.
Results: Among 107 patients, 47 male patients (43.9%) were included. The mean patient age was 51.6 (range 15-83) years and the mean follow-up duration was 11.1 (range 3-47) months. Pathologies were confirmed as 90 pituitary adenoma, 8 craniopharyngioma, 6 rathke's cleft cyst, 2 tuberculum sellae meningioma and 1 cavernous hemangioma. Nasoseptal flap was conducted in 24 patients (22.4%, 13 macroadenoma, 8 craniopharyngioma, 2 tuberculum sellae meningioma and 1 cavernous hemangioma). Nasal crust was the most frequent morbidity found in 26 (24.3%) cases followed by synechia in 16 (15.0%) cases at postoperative 3 month. Nasal discharge was found in 14 (13.1%) cases, polypoid mucosa in the sphenoid sinus was found in 8 cases (7.5%) and newly performed septal perforation was found in 6 cases (5.6%) at postoperative 3 month. There was one minimal saddle nose case after reoperation due to CSF leak. Nasal complication decreased along time except for septal perforation and synechia. NSF was associated with postoperative 3 month crust formation found in 15/24 (62.5%) cases (p=0.000). Septal perforation was found in anterior portion in 3 cases, mid portion in 2 cases, and posterior portion in 2 cases (one case had 2 perforations). Septal perforation was only found in the patients who performed NSF (p=0.000). NSF was performed in only 1 case of first 36 cases, 11 cases of second 36 cases, and 12 cases of third 35 cases. Newly performed septal perforation was found in 100% in the first period, 2/11 (18.2%) in the second period, 3/12 (25%) in the third period. Reoperation and postoperative CSF leak decreased with the patient number increased.
Conclusion: Nasal crust was the most frequent sinonasal morbidity after endoscopic TSA followed by synechia. NSF was associated with nasal crust and septal perforation and these sinonasal complication decreased with rhinologist's learning curve on NSF.