Rhinologic outcome of endoscopic transnasal-transsphenoidal pituitary surgery: an institutional series, systematic review, and meta-analysis

Abstract

Purpose: We aimed to summarize the available data on the objective rhinologic outcome after endoscopic transnasal-transsphenoidal (ETT) surgery.

Methods: Retrospective study on a consecutive cohort of treatment-naïve patients undergoing ETT pituitary gland surgery. Additionally, a systematic review and meta-analysis with focus on the rhinologic outcome, including postoperative smell function was performed.

Results: The institutional series incorporated 168 patients. A concomitant endoscopic septoplasty was performed in 29/168 patients (17.3%). A nasoseptal flap was used for reconstruction of large skull-base defects or high-flow CSF leaks in 4/168 (2.4%) patients. Early postoperative rhinologic complications (< 4 weeks) included epistaxis (3%), acute rhinosinusitis (1.2%) and late postoperative complications (≥ 8 weeks) comprised prolonged crusting (15.6%), symptomatic synechiae (11.9%) and septal perforation (0.6%). Postoperative smell function was not impaired (Fisher's exact test, p = 1.0). The systematic review included 19 studies on 1533 patients with a median postoperative epistaxis rate of 1.4% (IQR 1.0-2.2), a postoperative acute rhinosinusitis rate of 2.3% (IQR 2.1-3.0), a postoperative synechiae rate of 7.5% (IQR 1.8-19.1) and a postoperative septal perforation rate of 2.2% (IQR 0.5-5.4). Seven studies including a total of 206 patients reported adequate outcome measures for smell function before and after ETT surgery. Only 2/7 studies reported an impairment of smell function postoperatively, especially in patients with nasoseptal flap harvesting.

Conclusion: Early and late postoperative rhinologic complication rates after ETT surgery for pituitary lesions seem to be low. A thorough evaluation of smell function, in particular in patients at risk for nasoseptal flap harvesting, may be an important factor in optimal postoperative care.

Keywords: Endoscopic; Function; Nasal; Pituitary; Rhinologic; Transnasal-transsphenoidal.

Fig. 1

Details on the search strategy

Fig. 2

Early postoperative complication rates for all included studies matching the inclusion criteria for the meta-analysis (including our institutional series). Vertical line indicates median finding of all included studies (hatched area 1.–3. IQR). Median postoperative epistaxis rate (%, IQR): 1.4 (IQR 1.0–2.2). Median postoperative acute rhinosinusitis rate (%, IQR): 2.3 (IQR 2.1–3.0). IQR; interquartile range

Fig. 3

Late postoperative complication rates for all included studies matching the inclusion criteria for the meta-analysis (including our institutional series). Vertical line indicates median of all included studies (hatched area 1.–3. IQR IQR). Median postoperative synechiae rate (%, IQR): 7.5 (IQR 1.8–19.1). Median postoperative septal perforation rate (%, IQR): 2.2 (IQR 0.5–5.4). IQR; interquartile range