Transient Exacerbation of Nasal Symptoms following Endoscopic Transsphenoidal Surgery for Pituitary Tumors: A Prospective Study

Abstract

Object Endoscopic transsphenoidal surgery is the commonest approach to pituitary tumors. One disadvantage of this approach is the development of early postoperative nasal symptoms. Our aim was to clarify the peak onset of these symptoms and their temporal evolution. Methods The General Nasal Patient Inventory (GNPI) was administered to 56 patients undergoing endoscopic transsphenoidal surgery for pituitary tumors preoperatively and at 1 day, 3 days, 2 weeks, 3 months, and 6 to 12 months postoperatively. Most patients underwent surgery for pituitary adenomas ( N = 49; 88%) and through a uninostril approach ( N = 55; 98%). Total GNPI (0-135) and scores for the 45 individual components were compared. Results GNPI scores peaked at 1 to 3 days postoperatively, with rapid reduction to baseline by 2 weeks and below baseline by 6 to 12 months postsurgery ( p < 0.01). Of the 45 individual symptoms on the GNPI scale, 19 (42%) worsened transiently after surgery ( p < 0.05). Functioning tumors had a higher GNPI scores at postoperative day 1 and 3 than nonfunctioning tumors, although their temporal evolution was the same ( p < 0.05). Conclusions Nasal morbidity following endoscopic transsphenoidal pituitary surgery is common, but transient, more so in the functioning subgroup. Nasal symptoms improve below baseline by 6 to 12 months, without the need for specific long-term postoperative interventions in the vast majority of patients.

Keywords: GNPI; adenoma; endoscopic; nasal symptoms; pituitary tumor; transsphenoidal.

Fig. 1

Changes in total General Nasal Patient Inventory scores over time. Box plots depict the mean (horizontal black line), interquartile range (box), and the standard deviation values (tails). * p  < 0.05; ** p  < 0.01 versus preoperative value; repeated measures analysis of variance and posthoc Bonferroni test.

Fig. 2

Comparison of the total General Nasal Patient Inventory scores (mean ± standard error) over time for functioning compared with nonfunctioning pituitary tumors. * p  < 0.05; ** p  < 0.01 versus corresponding score for the other group at same time point; repeated measures analysis of variance and posthoc Bonferroni test.

Fig. 3

Temporal evolution of selected nasal symptoms. (A) My nose is blocked. (B) My nose bleeds. (C) I feel dripping at the back of my nose. (D) My nose runs. (E) My nose is painful to touch. (F) I have sores inside my nose. (G) My sense of smell is affected. (H) My work is affected. All symptoms peaked at 1 to 3 days postoperatively with the exception of “My work is affected” (H) .