Heo Kyung Wook, Park Seong Kook
Department of Otorhinolaryngology-Head and Neck Surgery, Inje University, College of Medicine, Busan Paik Hospital, Busan, Korea.
Am J Rhinol. 2008 Sep-Oct;22(5):533-6. doi: 10.2500/ajr.2008.22.3220.
The transsphenoidal approach (TSA) is the procedure of choice for the vast majority of pituitary neoplasms. Sinusitis is considered a contraindication to TSA because of possible transcranial spread of infection. This study was performed to determine if TSA for pituitary tumors could be extended to patients with pituitary adenoma and chronic rhinosinusitis (CRS).
Medical records, including rhinologic outcomes, were retrospectively assessed in 11 consecutive patients who underwent concurrent TSA and endoscopic sinus surgery (ESS) because of pituitary adenoma and CRS between May 2004 and October 2007.
The 11 patients consisted of 5 men and 6 women, with a mean age of 55 years (range, 31-69 years) and average follow-up of 24.4 months (range, 6-44 months). Preoperatively, all patients had symptoms of CRS, but none had acute exacerbation of rhinosinusitis. All patients had CRS and two had nasal polyps. TSA was via the transcolumellar transseptal approach in seven patients and the transnasal approach in four patients. No postoperative complications due to ESS were observed. Two patients, including one with sphenoid aspergillosis, had preoperative unilateral sphenoid sinusitis, which was managed by ESS on the involved side, with TSA performed concurrently through the contralateral healthy sphenoid sinus. There was one case of postoperative sphenoid sinusitis and one case of septal perforation due to TSA. There were no postoperative intracranial complications, including meningitis and brain abscess.
Concurrent TSA and ESS can be performed in selected patients with CRS and pituitary adenoma. Future studies should involve more patients and longer follow-ups.
经蝶窦入路（TSA）是绝大多数垂体肿瘤的首选手术方法。由于感染可能经颅扩散，鼻窦炎被认为是TSA的禁忌证。本研究旨在确定垂体肿瘤的TSA是否可扩展至垂体腺瘤合并慢性鼻-鼻窦炎（CRS）的患者。
回顾性评估2004年5月至2007年10月期间因垂体腺瘤和CRS同时接受TSA和鼻内镜鼻窦手术（ESS）的11例连续患者的病历，包括鼻科手术结果。
11例患者中，男性5例，女性6例，平均年龄55岁（范围31 - 69岁），平均随访24.4个月（范围6 - 44个月）。术前，所有患者均有CRS症状，但无鼻-鼻窦炎急性加重。所有患者均患有CRS，2例有鼻息肉。7例患者采用经鼻小柱鼻中隔入路行TSA，4例采用经鼻入路。未观察到ESS引起的术后并发症。2例患者，包括1例蝶窦曲霉菌病患者，术前有单侧蝶窦炎，通过患侧ESS处理，同时经对侧健康蝶窦行TSA。有1例术后蝶窦炎和1例因TSA导致的鼻中隔穿孔。无术后颅内并发症，包括脑膜炎和脑脓肿。
对于选定的CRS合并垂体腺瘤患者可同时行TSA和ESS。未来的研究应纳入更多患者并进行更长时间的随访。
