Department of Otorhinolaryngology, Johannes Wesling Hospital Minden, Minden, Germany.
Department of Neurosurgery, Johannes Wesling Klinikum, Universitätsklinikum der Ruhruniversität Bochum, Minden, Germany.
Exp Clin Endocrinol Diabetes. 2021 Mar;129(3):157-162. doi: 10.1055/a-1155-6269. Epub 2020 May 7.
Transsphenoidal surgery for sellar lesions may affect patency and function of the nasal airways, smell and sinonasal quality of life. Below is our report on otorhinolaryngological data garnered from patients undergoing endonasal transsphenoidal pituitary microsurgery.
In a prospective study, 68 patients scheduled for transsphenoidal operations (32 female, 36 male, age 17-72 years) underwent otorhinolaryngological evaluation of their nasal morphology, a standardized smell test (sniffin' sticks) and rhinomanometry to analyse nasal breathing function preoperatively, 3-5 days postoperatively (without rhinomanometry), after 3-4 months and after 9 months.
Immediately after surgery, a reduction in smell sensation was detected in almost all patients. Within 3 months, this impairment resolved in all cases except one. In 2 patients (3%) with preoperative anosmia, improvement of smell function to>6 out of 12 sniffin' sticks was observed. At final visit no patient was noted to have new anosmia. Within 3 months, the results of the rhinomanometry revealed that all patients except one, regained their preoperative nasal breathing function. In 6 patients (8.8%) an improvement in their nose breathing abilities compared to the preoperative state was found. Three patients (4.4%) underwent a LASER transection of mucosal synechiae. In one case with persistent nasal obstruction (1.5%), secondary septoplasty had to be performed. There was no case in which perforation of the nasal septum, nasal tip deflection, or saddle nose deformity was observed.
Microsurgical resection of pituitary tumors via the endonasal transsphenoidal approach poses an acceptable risk with regards to sinonasal complications. The incidence of secondary rhinosurgical interventions is low. Standardized comparative studies between endoscopic and microsurgical transsphenoidal operations should be undertaken.
经蝶窦手术治疗鞍区病变可能会影响鼻腔气道的通畅性和功能、嗅觉以及鼻-鼻窦生活质量。下面是我们报告的经鼻内镜下经蝶窦垂体显微手术患者的耳鼻喉科数据。
在一项前瞻性研究中，对 68 例行经蝶窦手术的患者（32 名女性，36 名男性；年龄 17-72 岁）进行了鼻形态学、标准化嗅觉测试（嗅棒）和鼻阻力测量的耳鼻喉科评估，分别于术前、术后 3-5 天（无鼻阻力测量）、术后 3-4 个月和 9 个月进行。
术后几乎所有患者的嗅觉均立即下降。3 个月内，除 1 例外，所有患者的嗅觉均恢复正常。在 2 例（3%）术前嗅觉丧失的患者中，观察到嗅觉功能改善至>12 嗅棒中的 6 分。最终随访时，无患者出现新的嗅觉丧失。术后 3 个月内，鼻阻力测量结果显示，除 1 例患者外，所有患者均恢复了术前的鼻腔通气功能。在 6 例（8.8%）患者中，与术前相比，其鼻腔通气能力得到了改善。6 例患者（8.8%）接受了黏膜粘连的 LASER 切开术。1 例（1.5%）持续鼻塞的患者需要进行鼻中隔成形术。未观察到鼻中隔穿孔、鼻尖偏曲或鞍鼻畸形的病例。
经鼻内镜下经蝶窦入路显微切除垂体瘤引起的鼻-鼻窦并发症风险可接受。需要进行二次鼻手术的比例较低。应该进行内镜和显微镜下经蝶窦手术的标准化比较研究。
