Sinusitis after Endoscopic Transsphenoidal Pituitary Surgery: Is Pre-Operative CT Imaging Predictive of Post-Operative Sinonasal Disease?

Objectives/Hypothesis: Endoscopic endonasal transsphenoidal approaches (TSAs) to sellar and parasellar tumors are generally well tolerated, however there are potential drawbacks with respect to post-operative sinonasal function. It has been observed that several patients who undergo this procedure ultimately require secondary sinus surgery. The objective of this study was to determine if radiographic anatomy of the paranasal sinuses is predictive of post-operative sinonasal disease in patients undergoing TSAs for sellar and parasellar tumors. Identification of potential risk factors would allow for the identification of a patient population who could benefit from more extensive pre-operative counseling, more frequent post-operative debridement, early initiation of medical therapy, or even endoscopic sinus surgery before/concomitant with pituitary surgery.

Study Design: Retrospective review.

Method: In 2011- 2012, 112 patients were admitted to our institution for TSA of sellar and parasellar tumors. A retrospective chart review with notation of patient characteristics, post-operative incidence of rhinosinusitis, and management strategy was performed. Additionally, pre-operative CT scans were analyzed with respect to Lund-Mackay staging, nasal height and width, and sphenoid height and width.

Results: 17 of 112 (15%) patients received a diagnosis of chronic or acute rhinosinusitis. There was no significant association between radiographic variables and post-TSA sinusitis in the overall population. However, there was a significant association between increasing sphenoid height and post-operative sinusitis among females. Moreover, the average sphenoid height was significantly greater in females with sinusitis compared with females without sinusitis (23mm versus 20 mm; p = 0.0324).

Conclusion: Increased sphenoid height in female patients is associated with post-TSA sinusitis.