Management of Rhinosinusitis in the Setting of Endoscopic Transsphenoidal Skull Base Surgery

Introduction: Endoscopic endonasal skull base surgery (ESBS) provides an important alternative approach to select cranial base pathologies. The potential for reduction in morbidity using these techniques has been acknowledged. However, there remains a paucity of data regarding management and potential complications in patients undergoing ESBS with rhinosinusitis. We review our patient experience and propose a clinical management algorithm for surgically addressing concurrent rhinosinusitis and skull base pathology.

Methods: A retrospective chart review identified patients who underwent both endoscopic sinus surgery (ESS) for inflammatory disease and endoscopic transsphenoidal skull base surgery at our tertiary-care institution.

Results: 38 patients were identified. Two patients (5.2%) had a sinus mycetoma, 19/38 (50%) had chronic rhinosinusitis (CRS) with nasal polyps, and the remainder (16/38, [44.7%]) had CRS without nasal polyps. Four of 38 (10.5%) were staged procedures with ESS followed by ESBS whereas 34/38 (89.5%) underwent concurrent surgery. Both of the patients with the sinus mycetoma were staged along with one case of medical refractory purulent rhinosinusitis. The fourth patient was staged based on his preference. Six of 38 (15.8%) developed post-operative sinusitis requiring antibiotic treatment. Two patients in the concurrent group required revision ESS for recurrent nasal polyposis. There were no cases of intraorbital or intracranial infectious complications.

Conclusions: Most cases of CRS and CRSP can be surgically managed at the time of ESBS without an increased risk of intracranial infection. Patients with medical refractory purulent CRS or a sinus fungus ball require staged procedures to avoid intracranial infectious complications.