Skip to main content
SpringerLink
Log in

Rhinologic Evaluation of Patients Undergoing Transsphenoidal Surgery

  • Chapter
  • First Online:
Transsphenoidal Surgery

Abstract

Transsphenoidal surgery, while considered minimally invasive compared to transcranial approaches, may still lead to significant issues if the delicate anatomy of the nasal cavity and paranasal sinuses is not evaluated and any comorbid disease not recognized. Preexisting anatomical variations such as septal deviation or concha bullosa of the turbinates may significantly limit access. Underlying sinonasal inflammation may predispose to increased difficulty of the surgery or protracted symptomatology during the postoperative course. Other patient issues such as the tumor pathology and/or hormone production must also be considered. A thorough history of the patient’s sinonasal history must be obtained and, when necessary, specialty consultation obtained in order to optimize the surgery and recovery periods. At times, this may require delay of the surgery in order to avoid the unexpected complications such as nasal scarring, chronic or recurrent sinusitis, or sinus mucoceles. This chapter will help direct the surgeon with preoperative assessment in order to optimize outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Schloffer H. Erfolgreiche operation eines hypophysentumors auf nasalem wege. Wien Klin Wochenschr. 1907;20:621–4.

    Google Scholar 

  2. Cohen-Gadol AA, Liu JK, Laws ER. Cushing’s first case of transsphenoidal surgery: the launch of the pituitary surgery era. J Neurosurg. 2005;103(3):570–4.

    Article  Google Scholar 

  3. Cushing H. The pituitary body and its disorders. Clinical states produced by disorders of the hypophysis cerebri. Philadelphia: JB Lippincott; 1912.

    Book  Google Scholar 

  4. Cappabianca P, Alfieri A, Colao A, et al. Endoscopic endonasal transsphenoidal approach: an additional reason in support of surgery in the management of pituitary lesions. Skull Base Surg. 1999;9:109–17.

    Article  CAS  Google Scholar 

  5. Frank G, Pasquini E, Farneti G, et al. The endoscopic versus the traditional approach in pituitary surgery. Neuroendocrinol. 2006;83:240–8.

    Article  CAS  Google Scholar 

  6. Jankowski R, Auque J, Simon C, et al. Endoscopic pituitary tumor surgery. Laryngoscope. 1992;102:198–202.

    Article  CAS  Google Scholar 

  7. Charalampaki P, Ayyad A, Kockro RA, et al. Surgical complications after endoscopic transsphenoidal pituitary surgery. J Clin Neurosci. 2009;16:786–9.

    Article  Google Scholar 

  8. Jho HD, Carrau RL. Endoscopic endonasal trans- sphenoidal surgery: experience with 50 patients. J Neurosurg. 1997;87:44–51.

    Article  CAS  Google Scholar 

  9. Dehdashti AR, Ganna A, Karabatsou K, Gentili F. Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery. 2008;62:1006–15.

    Article  Google Scholar 

  10. Kellman RM, Schmidt C. The paranasal sinuses as a protective crumple zone for the orbit. Laryngoscope. 2009;119:1682–90.

    Article  Google Scholar 

  11. Lee TS, Kellman RM, Darling A. Crumple zone effect of nasal cavity and paranasal sinuses on posterior cranial fossa. Laryngoscope. 2014;124(10):2241–6.

    Article  Google Scholar 

  12. Grunstein RR, Ho KY, Sullivan CE. Sleep apnea in acromegaly. Ann Intern Med. 1991;115(7):527–32.

    Article  CAS  Google Scholar 

  13. Fatti LM, Scacchi M, Pincelli AI, et al. Prevalence and pathogenesis of sleep apnea and lung disease in acromegaly. Pituitary. 2001;4:259–62.

    Article  CAS  Google Scholar 

  14. Shipley JE, Schteingart DE, et al. Sleep architecture and sleep apnea in patients with Cushing’s disease. Sleep. 1992;15(6):514–8.

    Article  CAS  Google Scholar 

  15. Kaw R, Pasupuleti V, Walker E, et al. Postoperative complications in patients with obstructive sleep apnea. Chest. 2012;141(2):436–41.

    Article  Google Scholar 

  16. Gupta RM, Parvizi J, Hanssen AD, Gay PC. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clin Proc. 2001;76:897–905.

    Article  CAS  Google Scholar 

  17. Nyquist GG, Anand VK, Brown S, et al. Middle turbinate preservation in endoscopic transsphenoidal surgery of the anterior skull base. Skull Base. 2010;20(5):343–7.

    Article  Google Scholar 

  18. Batra PS, Citardi MJ, Lanza DC. Isolated sphenoid sinusitis after transsphenoidal hypophysectomy. Am J Rhinol. 2005;19(2):185–9.

    Article  Google Scholar 

  19. Lu YJ, Chang CN, Pai PC, et al. Isolated sphenoid sinusitis or mucocele: a potential complication of endonasal transsphenoidal surgery. J Neurobiol. 2009;91(1):63–7.

    Google Scholar 

  20. Herman P, Lot G, Guichard JP, et al. Mucocele of the sphenoid sinus: a late complication of transsphenoidal pituitary surgery. Ann Otol Rhinol Laryngol. 1998;107(9):765–8.

    Article  CAS  Google Scholar 

  21. Giordano M, Gerganoc VM, Draf W, Fahlbusch R. Sphenoid sinus pyocele after transsphenoidal approach for pituitary adenoma. Pituitary. 2012;15:188–92.

    Article  Google Scholar 

  22. de Almeida JR, Snyderman CH, Gardner PA, et al. Nasal morbidity following endoscopic skull base surgery: a prospective cohort study. Head Neck. 2011;33:547–51.

    Article  Google Scholar 

  23. Magro E, Graillon T, Lassave J, et al. Complications related to the endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary macroadenomas in 300 patients. World J Neurosurg. 2016;89:442–53.

    Article  Google Scholar 

  24. Pledger CL, Elzoghby MA, Oldfield EH, et al. Prospective comparison of sinonasal outcomes after microscopic sublabial or endoscopic endonasal transsphenoidal surgery for nonfunctioning pituitary adenomas. J Neurosurg. 2016;125(2):323–33.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Virginia School of Medicine, Charlottesville, VA, USA

    Michael Freeman

  2. Department of Otolaryngology, Head & Neck Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA

    Jose Gurrola II

  3. Department of Otolaryngology, Head & Neck Surgery, Division of Allergy & Clinical Immunology, University of Virginia School of Medicine, Charlottesville, VA, USA

    Spencer C. Payne

Authors
  1. Michael Freeman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jose Gurrola II
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Spencer C. Payne
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Spencer C. Payne .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Harvard Medical School Brigham and Women’s Hospital, Boston, MA, USA

    Edward R. Laws, Jr

  2. Department of Neurosurgery, Indianapolis Methodist Hospital, Indianapolis, IN, USA

    Aaron A. Cohen-Gadol

  3. Department of Neurosurgery, Weill Cornell Medical College New York Presbyterian Hospital, New York, NY, USA

    Theodore H. Schwartz

  4. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA

    Jason P. Sheehan

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Freeman, M., Gurrola, J., Payne, S.C. (2017). Rhinologic Evaluation of Patients Undergoing Transsphenoidal Surgery. In: Laws, Jr, E.R., Cohen-Gadol, A.A., Schwartz, T.H., Sheehan, J.P. (eds) Transsphenoidal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-56691-7_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-56691-7_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-56689-4

  • Online ISBN: 978-3-319-56691-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation