Department of Neurosurgery, Antalya Training and Research Hospital, Antalya, Turkey.
Department of Otolaryngology (ENT)/Head and Neck Surgery, Antalya Training and Research Hospital, Antalya, Turkey.
World Neurosurg. 2022 Aug;164:e824-e829. doi: 10.1016/j.wneu.2022.05.059. Epub 2022 May 30.
We evaluated the frequency of nasal pathologies and the significance of surgical access to the sellar region in patients who underwent an operation for sellar mass using the endonasal and microscopic transsphenoidal approaches.
We retrospectively evaluated all patients who underwent surgery for pituitary macroadenoma using microscopic (n = 78) and endonasal (n = 20) transsphenoidal approaches. Patients' epicrisis, preoperative, and postoperative imaging as well as their operative notes were reviewed. Nasal pathologies and surgeries performed before or during the pituitary surgery were also documented. All endonasal surgeries were binostril and performed jointly by an ear, nose, and throat specialist and neurosurgeon. To determine the feasibility of endonasal and microscopic approaches, we developed an algorithm using the septum deviation classifications to determine the need for septoplasty.
The most common nasal pathology was septum deviation (n = 17; 17.3%). Of the other nasal pathologies, 6 cases (6%) were chronic sinusitis and 2 were (2.1%) middle turbinate bullosa.
The preoperative evaluation of patients undergoing endonasal transsphenoidal surgery by an ear, nose, and throat surgeon allows for the detection and treatment of nasal pathologies that may lead to serious perioperative and postoperative complications. Evaluating patients with septum deviation using our classification will help determine the necessity of preoperative or perioperative septum surgery, depending on the preferred pituitary surgical method.
我们评估了经鼻内镜和显微镜经蝶窦入路治疗鞍区肿块患者的鼻腔病变频率和蝶鞍区手术入路的重要性。
我们回顾性评估了所有经显微镜（n=78）和经鼻内镜（n=20）经蝶窦入路手术治疗垂体大腺瘤的患者。回顾了患者的病史、术前和术后影像学资料以及手术记录。记录了术前或术中进行的鼻腔病变和手术。所有经鼻内镜手术均为双鼻孔入路，由耳鼻喉科专家和神经外科医生共同完成。为了确定经鼻内镜和显微镜入路的可行性，我们开发了一种算法，使用鼻中隔偏曲分类来确定是否需要鼻中隔成形术。
最常见的鼻腔病变是鼻中隔偏曲（n=17；17.3%）。其他鼻腔病变中，慢性鼻窦炎 6 例（6%），中鼻甲泡状中鼻甲 2 例（2.1%）。
耳鼻喉科医生在对接受经鼻内镜蝶窦入路手术的患者进行术前评估时，可以发现并治疗可能导致严重围手术期和术后并发症的鼻腔病变。使用我们的分类评估鼻中隔偏曲患者，将有助于根据首选的垂体手术方法确定是否需要术前或围手术期鼻中隔手术。
