====== Rhinological Consequences after transsphenoidal approach ======

[[Transsphenoidal surgery]] for [[sellar lesion]]s may affect patency and function of the [[nasopharyngeal airway]]s, [[smell]] and [[sinonasal]] [[quality of life]]. 

In a [[prospective]] [[study]], 68 [[patient]]s scheduled for [[transsphenoidal]] [[operation]]s (32 female, 36 male, age 17-72 years) underwent otorhinolaryngological [[evaluation]] of their nasal morphology, a standardized [[smell]] [[test]] ([[Sniffin’ Sticks test]]) and [[rhinomanometry]] to analyze [[nasal breathing]] function preoperatively, 3-5 days postoperatively (without rhinomanometry), after 3-4 months and after 9 months.

Immediately after surgery, a reduction in [[smell]] sensation was detected in almost all patients. Within 3 months, this impairment resolved in all cases except one. In 2 patients (3%) with preoperative [[anosmia]], improvement of smell function to > 6 out of 12 sniffin' sticks was observed. At the final visit, no patient was noted to have new anosmia. Within 3 months, the results of the rhinomanometry revealed that all patients except one regained their preoperative nasal breathing function. In 6 patients (8.8%) improvement in their nose breathing abilities compared to the preoperative state was found. Three patients (4.4%) underwent a LASER transection of mucosal [[synechia]]e. In one case with persistent [[nasal obstruction]] (1.5%), secondary [[septoplasty]] had to be performed. There was no case in which perforation of the [[nasal septum]], [[nasal tip]] deflection, or [[external nasal deformity]] was observed.

Microsurgical [[resection]] of [[pituitary tumor]]s via the [[endonasal]] [[transsphenoidal approach]] poses an acceptable [[risk]] with regards to [[sinonasal]] [[complication]]s. The [[incidence]] of secondary rhinosurgical interventions is low. Standardized comparative studies between endoscopic and microsurgical transsphenoidal operations should be undertaken
((Hondronikos N, Alomari A, Schrader M, Knappe UJ. Rhinological Consequences of 
Microsurgical Endonasal-Transsphenoidal Surgery for Pituitary Tumors. Exp Clin
Endocrinol Diabetes. 2020 May 7. doi: 10.1055/a-1155-6269. [Epub ahead of print] 
PubMed PMID: 32380562.
)).
----
A high incidence of nasal complications after conventional transsphenoidal surgery observed through examination and not reported spontaneously point to the need of otorhinolaryngological investigation complemented by nasal endoscopy in patients submitted to procedures through this route
((Petry C, Leães CG, Pereira-Lima JF, Gerhardt KD, Sant GD, Oliveira Mda C.
Oronasal complications in patients after transsphenoidal hypophyseal surgery.
Braz J Otorhinolaryngol. 2009 May-Jun;75(3):345-9. English, Portuguese. PubMed
PMID: 19649482.
))

Olfactory dysfunction 

The patients must be informed that their olfaction may be impaired
((Kim BY, Kang SG, Kim SW, Hong YK, Jeun SS, Kim SW, Kim HB, Kim M, Maeng JH,
Lee DC, Cho JH, Park YJ. Olfactory changes after endoscopic endonasal
transsphenoidal approach for skull base tumors. Laryngoscope. 2014 Mar 13. doi:
10.1002/lary.24674. [Epub ahead of print] PubMed PMID: 24623575.)).

Obstruction

The percentage of nasal obstruction and nasal crusting was 38% in Monnier's series evaluating the transvestibular transeptal approach
((Monnier DS. Séquelles endonasales après hypophysectomie. Ann Otolaryngol Chir Cervicofac. 1998;115:49-53. )).

Chronic nasal irritation was seen in only 2% of cases in Feigenbaun et al.'s series
((Feigenbaum SL, Downey DE, Wilson CB, Jaffe RB. Transsphenoidal pituitary resection for preoperative diagnosis of prolactin-secreing pituitary neuroendocrine tumor in women: long term follow-up. J Clin Endocrinol Metab. 1996;81(5):1711-19)).
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A study assessed the long-term impact of [[endoscopic skull base surgery]] on olfaction, sinonasal symptoms, [[mucociliary clearance]] time (MCT), and quality of life (QoL). Patients with pituitary neuroendocrine tumors underwent TTEA (n = 38), while patients with other benign parasellar tumours who underwent an EEA with vascularised [[nasoseptal flap]] reconstruction (n = 17) were enrolled in this prospective study between 2009 and 2012. Sinonasal symptoms (Visual Analogue Scale), subjective olfactometry (Barcelona Smell Test-24, BAST-24), MCT (saccharin test), and QoL (short form SF-36, rhinosinusitis outcome measure/RSOM) were evaluated before, and 12 months after, surgery. At baseline, sinonasal symptoms, MCT, BAST-24, and QoL were similar between groups. Twelve months after surgery, both TTEA and EEA groups experienced smell impairment compared to baseline. Moreover, EEA (but not TTEA) patients reported increased posterior nasal discharge and longer MCTs compared to baseline. No significant changes in olfactometry or QoL were detected in either group 12 months after surgery. Over the long-term, expanded skull base surgery, using EEA, produced more sinonasal symptoms (including loss of smell) and longer MCTs than pituitary surgery (TTEA). EEA showed no long-term impact on smell test or QoL
((Rioja E, Bernal-Sprekelsen M, Enriquez K, Enseñat J, Valero R, de Notaris M,
Mullol J, Alobid I. Long-term outcomes of endoscopic endonasal approach for skull
base surgery: a prospective study. Eur Arch Otorhinolaryngol. 2016
Jul;273(7):1809-17. doi: 10.1007/s00405-015-3853-9. Epub 2015 Dec 19. PubMed
PMID: 26688432.
)).