Olfactory outcomes after endoscopic transsphenoidal pituitary surgery

Area of Science:

• Otolaryngology
• Neurosurgery
• Olfactory Neuroscience

Background:

• Olfaction significantly impacts patient quality of life.
• Endoscopic transsphenoidal pituitary surgery may damage olfactory tissues, but this is underreported.
• Understanding olfactory outcomes is crucial for surgical practice.

Purpose of the Study:

• To evaluate olfactory function changes after endoscopic transsphenoidal pituitary surgery.
• To document olfactory outcomes using standardized tests and patient reports.
• To investigate potential causes of olfactory dysfunction in this surgical context.

Main Methods:

• Prospective cohort study involving 17 patients undergoing endoscopic transsphenoidal pituitary surgery.
• Olfactory function assessed using the University of Pennsylvania Smell Identification Test (UPSIT) preoperatively and at 6 months postoperatively.
• Secondary outcomes included Lund-Kennedy endoscopy scores (LKES) and patient self-reported olfactory disturbance; paired t-tests were used for analysis.

Main Results:

• A statistically significant decline in mean UPSIT scores from 37.2 (normosmia) to 30.8 (moderate hyposmia) (P < .001).
• All patients reported olfactory dysfunction, despite normal healing and LKES scores at 6 months.
• The study highlights a consistent pattern of olfactory impairment following this surgical procedure.

Conclusions:

• This is the first study to detail postoperative olfactory issues after endoscopic transsphenoidal pituitary surgery.
• The Hadad-Bassagasteguy (HB) vascularized septal flap is hypothesized as a cause of olfactory impairment.
• Routine counseling on potential permanent olfactory changes and judicious use of HB flaps are recommended.