Introduction: Both endoscopic and microscopic transsphenoidal approaches are commonly used for resection of pituitary adenomas. However, no prospective studies have compared sinonasal and quality of life outcomes in a concurrent series of patients.
Methods: Patients with nonfunctioning adenomas undergoing transsphenoidal surgery were included. We measured sinonasal function, quality of life and pain using SNOT-20, NOSE, SF-36 and a headache scale. Seventy-nine patients undergoing either endoscopic (n=46) or microscopic (n=33) surgery were surveyed preoperatively and up to one year after surgery.
Results: All patients experienced a similar recovery pattern with initial increase in symptoms during the first 2 weeks, return to baseline by 4 weeks, and improvement by 8 weeks. Patients undergoing endoscopic surgery experienced better sinonasal outcomes at 24-48 hours (SNOT total p = 0.015), 2 weeks (NOSE p = 0.013), and 8 weeks (SNOT total p = 0.032). At 8 weeks endoscopic patients had significantly less severe headaches (p = 0.023). There were no significant differences at any time point between the two groups for the SF-36. By one year, there were no significant differences in sinonasal outcomes between the groups.
Conclusions: Patients undergoing transsphenoidal surgery experience the greatest symptoms at two weeks postoperatively and a similar time course of recovery in nasal, headache and quality of life assessments. Although patients undergoing endoscopic surgery experienced significantly fewer nasal symptoms during the first two months, by one year after surgery, there were no significant differences between the groups.
Patient Care: This series sheds light on common sinonasal outcomes after transsphenoidal surgery, and their timeline for improvement. It helps surgeons consider in greater detail the benefits and limitations of different approaches for transsphenoidal surgery
Learning Objectives: Understand the effect of surgical approach for transsphenoidal resection of pituitary adenomas on sinonasal outcomes