Introduction: Endoscopic endonasal pituitary surgery is becoming the standard approach. The need for unilateral middle turbinate resection during the endonasal approach remains controversial and the long term implications for sinonasal function are unknown. This study aims to quantify sinonasal morbidity after endoscopic pituitary surgery using the validated SinoNasal Outcome Test (SNOT).
Methods: A prospective study of 32 consecutive patients undergoing endoscopic endonasal pituitary surgery for pituitary adenoma. Patients undergoing revision surgery or those patients with giant macroadenomas requiring naso-septal flap reconstruction were excluded. In all cases the right middle turbinate was resected at the beginning of the procedure and the harvested free turbinate mucosal graft used to close the sella defect. Patients were assessed at 6 weeks and 6 months post-operatively using the SNOT questionnaire and the use of nasal rinses and antibiotics recorded.
Results: The mean SNOT score was 32 at 6 weeks and 23 at 6 months (p=0.001). No patients had CSF leak post-operatively. 4 (12.5%) patients required antibiotics at 6 weeks and 4 patients required nasal saline rinses beyond 6 weeks. SNOT scores above 4 occurred mainly in the domain related to sleep function and persisted at 6 months in 9 (28%) patients. No patients reported persistent nasal symptoms at 6 months.
Conclusions: Middle turbinate resection has minimal adverse effect on sinonasal function with most patients reporting minimal nasal symptoms beyond 6 weeks. Questions related to sleep function may reflect other underlying medical factors and may not be impacted by surgical intervention.
Patient Care: Patient care will be improved by increasing our understanding of the impact of surgical procedures on quality of life.
Learning Objectives: By the conclusion of this session, participants should be able to discuss the approach for endoscopic endonasal transphenoidal pituitary surgery and it's impact on nasal function