Long-term olfactory dysfunction after single-nostril endoscopic transnasal transsphenoidal pituitary adenoma surgery

Over the past decade, the endoscopic transnasal transsphenoidal approach for pituitary adenomas has been widely adopted among neurosurgeons. However, olfactory disturbances have been observed after this procedure, and few studies on long-term (>6 mo) olfactory disturbance after endoscopic transnasal transsphenoidal pituitary adenoma surgery have been conducted. Although we perform minimally invasive endoscopic surgery, some patients continue to experience hyposmia, with some even experience long-term hyposmia. This impairment results in a considerable loss in quality of life. We present a series of patients who underwent minimally invasive single-nostril TSS for pituitary adenoma, including evaluation of their olfactory function. We further investigated the related risk factors for long-term olfactory dysfunction.

One hundred sixty-one consecutive patients who met the study criteria underwent the single-nostril endoscopic transsphenoidal approach by the senior author. The Smell Diskettes Olfaction Test was used to evaluate olfactory function.

Postoperative olfactory disturbance in patients treated with endoscopic transnasal TSS is frequent. Of the study population, 67.1% of the patients were hyposmic or anosmic and 14.9% had long-term olfactory dysfunction. We also performed multivariate logistic regression analysis to compare the characteristics of patients with long-term olfactory dysfunction. Nasal symptoms (odds ratio [OR], 6.77) and smoking (OR, 14.77) were associated with long-term olfactory dysfunction after transnasal TSS.

Significant disturbances in olfactory performance occur after single-nostril transnasal TSS for pituitary adenoma. Furthermore, preoperative nasal disease and smoking appear to be risk factors for long-term olfactory dysfunction. Physicians should address clinical findings related to olfactory function and provide appropriate care.