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Late Postoperative Rhinological Complications After Microscopic Transnasal Hypophysectomy

Lutfi Postalci1, Ibrahim Erdim, Bulent Demirgil

  • 1Bakirkoy Research and Training Hospital for Neurology, Psychiatry and Neurosurgery, Neurosurgery Clinic, Istanbul, Turkey.

Turkish Neurosurgery
|September 6, 2016
PubMed
Abstract

Insights

Microscopic transnasal hypophyseal surgery (MTHS) for pituitary adenoma can lead to frequent, late-occurring rhinological issues like septal perforation and synechiae. Gentle handling of nasal structures during MTHS is crucial to minimize these complications.

Area of Science:

  • Otorhinolaryngology
  • Neurosurgery
  • Endocrinology

Background:

  • Major complications of microscopic transnasal hypophyseal surgery (MTHS) are rare, but late-occurring rhinological issues can be overlooked.
  • Pituitary adenoma treatment via MTHS necessitates a thorough understanding of potential post-operative nasal complications.

Purpose of the Study:

  • To investigate the incidence and types of late rhinological complications following MTHS for pituitary adenoma.
  • To highlight the importance of addressing less common, yet significant, post-surgical nasal issues.

Main Methods:

  • Retrospective analysis of 31 patients who underwent MTHS for pituitary adenoma between January 2007 and January 2014.
  • Preoperative nasal examinations were recorded, and detailed postoperative rhinological examinations were performed.

Main Results:

  • A high incidence of rhinological complications was observed: 38.7% septal perforation and 42% nasal synechiae.
  • Other complications included anosmia (9.7%), hyposmia (6.5%), nasal tip deflection, and saddle nose deformity (3.2%).
  • No cases of perinasal sense loss, oronasal fistula, or purulent nasal discharge were reported.

Conclusions:

  • Gentle manipulation of nasal structures, especially the nasal septum mucosa, is essential during MTHS.
  • Collaboration with an otolaryngologist is recommended for the nasal stages of MTHS until sufficient surgical experience is attained.

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