Transnasal endoscopic pituitary surgery – role of the size of the posterior septum resection on nasal functions

Czech version

Authors: J. Lubojacký ^1,2 ; Petr Matoušek ^1,2 ; L. Čábalová ^1,2 ; Pavel Komínek ^1,2
Authors‘ workplace: Klinika otorinolaryngologie a chirurgie hlavy a krku, FN Ostrava ¹; Katedra kraniofaciálních oborů, Lékařská fakulta OU, Ostrava ²
Published in: Otorinolaryngol Foniatr, 74, 2025, No. 3, pp. 202-206.
Category: Original Article
doi: https://doi.org/10.48095/ccorl2025202

Overview

Introduction: Due to its minimal invasiveness, transnasal endoscopic surgery using the binostral approach is currently the method of choice in the treatment of pituitary adenoma. We frequently perform surgery in a healthy nasal cavity, therefore there is a risk of damaging nasal functions, especially the sense of smell. The relationship between the length of the nasal septum resection and postoperative olfactory impairment is not described in the current literature. Aims: The aims of the study were to evaluate whether the different length of resection of the posterior part of the nasal septum has an effect on the deterioration of smell and quality of life after surgery, and whether the different length of the septum resection has an effect on the maneuverability and clarity of the operative field. Materials and methodology: Prospective study of patients indicated for transnasal endoscopic extirpation of a pituitary adenoma via the binostral approach. Patients were divided into two groups, group A –⁠ 1-cm resection and group B –⁠ 2-cm resection of the posterior part of the nasal septum. The sense of smell using the odorized markers test (OMT) and quality of life using the SNOT-22 questionnaire were evaluated preoperatively and 4 months postoperatively. Maneuverability and clarity of the operative field were evaluated for both groups. Results: A total of 42 patients, with a median age of 62 years, were included in the study. Deterioration of smell occurred in 2/42 (4.8%) patients, and the average value of OMT after surgery was 9 points. The average value of SNOT-22 after surgery was 12 points, and deterioration of quality of life occurred in 2/42 (4.8%) patients. There was no significant difference between 1 -⁠ and 2-cm septal resection in any of the monitored parameters of nasal functions. Maneuverability in the nasal cavity was significantly better in the group with greater septal resection, when 18/21 (85.7%) patients achieved excellent values. Conclusion: There was no statistically significant difference in postoperative results of olfaction and quality of life between the two groups. Maneuverability was significantly better in the group with greater resection of the nasal septum. Transnasal endoscopic binostral approach is the method of choice for surgical removal of a pituitary adenoma, where a 2-cm resection of the nasal septum offers better maneuverability during surgery, and at the same time does not have a higher risk of damage to nasal functions.

Keywords:

Pituitary adenoma – transnasal endoscopic resection – binostral approach – nasal functions

Sources

Literatura

1. Messerer M, Cossu G, George M et al. Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas. J Vis Exp 2018; (131): 55896. Doi: 10.3791/55896.

2. Regmi D, Thapa A, Kc B et al. Endoscopic Endonasal Transsphenoidal Approach to Pituitary Adenoma: A Multi-disciplinary Approach. J Nepal Health Res Counc 2017; 15 (2): 174–177. Doi: 10.3126/jnhrc.v15i2.18209.

3. Netuka D, Masopust V, Beneš V. Léčba adenomů hypofýzy. Cesk Slov Neurol N 2011; 74/107 (3): 240–253.

4. Rochet M, El-Hage W, Richa S et al. Depression, Olfaction, and Quality of Life: A Mutual Relationship. Brain Sci 2018; 8 (5): 80. Doi: 10.3390/brainsci8050080.

5. Croy I, Nordin S, Hummel T. Olfactory disorders and quality of life-an updated review. Chem Senses 2014; 39 (3): 185–194. Doi: 10.1093/chemse/bjt072.

6. Schreiber A, Bertazzoni G, Ferrari M et al. Nasal Morbidity and Quality of Life After Endoscopic Transsphenoidal Surgery: A Single-Center Prospective Study. World Neurosurg 2019; 123: e557–e565. Doi: 10.1016/j.wneu.2018.11.212.

7. Sergeant MJT, Davies MN, Dickins TE et al. The self-reported importance of olfaction during human mate choice. Sexualities, Evolution & Gender 2005; 7 (3): 199–213. Doi: 10.1080/14616660500173685.

8. Rotenberg B, Tam S, Ryu WH et al. Microscopic versus endoscopic pituitary surgery: a systematic review. Laryngoscope 2010; 120 (7): 1292–1297. Doi: 10.1002/lary.20949.

9. Soyka MB, Serra C, Regli L et al. Long-term olfactory outcome after nasoseptal flap reconstructions in midline skull base surgery. Am J Rhinol Allergy 2017; 31 (5): 334–337. Doi: 10.2500/ajra.2017.31.4463.

10. Kassam AB, Prevedello DM, Carrau RL et al. Endoscopic endonasal skull base surgery: analysis of complications in the authors‘ initial 800 patients. J Neurosurg 2011; 114 (6): 1544–1568. Doi: 10.3171/2010.10.JNS09406.

11. Wu V, Cusimano MD, Lee JM. Extent of surgery in endoscopic transsphenoidal skull base approaches and the effects on sinonasal morbidity. Am J Rhinol Allergy 2018; 32 (1): 52–56. Doi: 10.2500/ajra.2018.32.4499.

12. Kim do H, Hong YK, Jeun SS et al. Anatomic Changes Caused by Endoscopic Endonasal Transsphenoidal Surgery and Their Effects on Nasal Functions. Otolaryngol Head Neck Surg 2016; 154 (6): 1132–1137. Doi: 10.1177/0194599816630726.

13. Kim DH, Hong YK, Jeun SS et al. Intranasal Volume Changes Caused by the Endoscopic Endonasal Transsphenoidal Approach and Their Effects on Nasal Functions. PLoS One 2016; 11 (3): e0151531. Doi: 10.1371/journal.pone.0151531.

14. Eccles R. Nasal airflow in health and disease. Acta Otolaryngol 2000; 120 (5): 580–595. Doi: 10.1080/000164800750000388.

15. Gallagher MJ, Durnford AJ, Wahab SS et al. Patient-reported nasal morbidity following endoscopic endonasal skull base surgery. Br J Neurosurg 2014; 28 (5): 622–625. Doi: 10.3109/02688697.2014.887656.

16. Vodička J, Faitlová H, Chrobok V. Poruchy čichu a chuti. In: Vodička J, Dudová I, Matoušek P. Příčiny poruchy čichu. 1st ed. Havlíčkův Brod: Tobiáš 2012 : 76–117.

17. Yan CH, Rathor A, Krook K et al. Effect of Omega-3 Supplementation in Patients With Smell Dysfunction Following Endoscopic Sellar and Parasellar Tumor Resection: A Multicenter Prospective Randomized Controlled Trial. Neurosurgery 2020; 87 (2): E91–E98. Doi: 10.1093/neuros/nyz559.

18. Sowerby LJ, Gross M, Broad R et al. Olfactory and sinonasal outcomes in endoscopic transsphenoidal skull-base surgery. Int Forum Allergy Rhinol 2013; 3 (3): 217–220. Doi: 10.1002/alr.21103.

19. Chaaban MR, Chaudhry AL, Riley KO et al. Objective assessment of olfaction after transsphenoidal pituitary surgery. Am J Rhinol Allergy 2015; 29 (5): 365–368. Doi: 10.2500/ajra.2015.29.4206.

20. Croft CB. Clinical Anatomy of the Nose, Nasal Cavity and Paranasal Sinuses. Clin Otolaryngol Allied Sci 1991; 16 (4): 430–430. Doi: 10.1111/j.1365-2273.1991.tb02084.x.

21. Netuka D, Masopust V, Fundová P et al. Olfactory Results of Endoscopic Endonasal Surgery for Pituitary Adenoma: A Prospective Study of 143 Patients. World Neurosurg 2019; 129: e907–e914. Doi: 10.1016/j.wneu.2019.05.061.

22. Hart CK, Theodosopoulos PV, Zimmer LA. Olfactory changes after endoscopic pituitary tumor resection. Otolaryngol Head Neck Surg 2010; 142 (1): 95–97. Doi: 10.1016/j.otohns.2009.09.032.

23. Lubojacký J, Matoušek P, Lipina R et al. Poruchy čichu po transnazálních endoskopických operacích adenomu hypofýzy. Cesk Slov Neurol N 2022, 85/118 (1): 33–37. Doi: 10.48095/cccsnn202233.

24. Lubojacký J, Čábalová L, Hránková V et al. Transnasal Endoscopic Pituitary Surgery-The Role of a CT Scan in Individual Tailoring of Posterior Septum Size Resection. Tomography 2023; 12; 9 (6): 2222–2232. Doi: 10.3390/tomography9060172.