Isolated sphenoid sinusitis after transsphenoidal hypophysectomy

Literature addressing the incidence and management of sinusitis after transsphenoidal hypophysectomy is sparse.

Retrospective chart analysis was conducted on 200 consecutive patients who had undergone transsphenoidal procedures between January 1998 and December 2001. The postoperative incidence of sinusitis was determined. Clinical characteristics, management strategy, and outcome were reviewed.

Fifteen of the 200 patients (7.5%) developed rhinosinusitis after transsphenoidal surgery. Seven of the patients were referred to otorhinolaryngology for further management. Three additional patients, who had undergone transsphenoidal hypophysectomy at outside institutions, also were evaluated during this time. Nine of 10 patients (90%) had isolated sphenoid sinusitis by computed tomography and/or endoscopic criteria. The most common symptoms included headaches and nasal discharge present for an average of 2.9 years. Medical management resulted in resolution of symptoms in 5 of 10 cases (50%). The remaining five patients required endoscopic sphenoidotomy for recalcitrant disease. Intraoperatively, fungal balls were identified in three cases. Mucocele formation was encountered in one case, and an infected fat graft was evident in one case. Sphenoid sinusitis was resolved successfully in all 10 cases.

A high index of suspicion must be maintained to avoid an inordinate delay in diagnosis of isolated sphenoid sinusitis in this setting, in light of the nonspecific presentation of this clinical entity. Aggressive medical and/or surgical treatment is required for resolution of refractory symptoms in this patient population.