Nasal morbidity and complications after endoscopic transsphenoidal pituitary adenoma surgery

Endoscopic transnasal transsphenoidal (ETT) surgery has become the standard approach for pituitary adenoma resection, yet postoperative nasal morbidity remains a concern. This study aims to evaluate rhinologic outcomes after ETT surgery, characterize the types and frequencies of postoperative nasal complications, and assess the effectiveness of treatment strategies. The primary research question addresses the incidence and reversibility of nasal morbidity following ETT surgery.

A retrospective review was performed on 414 patients who underwent ETT surgery for pituitary adenomas at our institution between August 2015 and August 2025. Postoperative nasal complaints and complications were documented, including epistaxis, sinusitis, nasal adhesions, olfactory disturbances, and crusting. Clinical outcomes following targeted treatments were analyzed.

Seventeen patients (4.1%) experienced postoperative nasal complications. These included epistaxis (n = 2), isolated sphenoid sinusitis (n = 3), nasal adhesions (n = 4), olfactory disorders (n = 2), and nasal crusting (n = 6). All complications were managed conservatively or with minor interventions, and all affected patients experienced clinical improvement and symptom resolution during follow-up.

Postoperative rhinologic complication rates following ETT surgery for pituitary adenomas are low and generally reversible with appropriate management. These findings support the safety of the ETT approach while emphasizing the importance of careful perioperative planning and postoperative nasal care.