Transnasal endoscopic pituitary surgery – role of the size of the posterior septum resection on nasal functions

Introduction: Due to its minimal invasiveness, transnasal endoscopic surgery using the binostral approach is currently the method of choice in the treatment of pituitary adenoma. We frequently perform surgery in a healthy nasal cavity, therefore there is a risk of damaging nasal functions, especially the sense of smell. The relationship between the length of the nasal septum resection and postoperative olfactory impairment is not described in the current literature. Aims: The aims of the study were to evaluate whether the diff erent length of resection of the posterior part of the nasal septum has an eff ect on the deterioration of smell and quality of life after surgery, and whether the diff erent length of the septum resection has an eff ect on the maneuverability and clarity of the operative field. Materials and methodology: Prospective study of patients indicated for transnasal endoscopic extirpation of a pituitary adenoma via the binostral approach. Patients were divided into two groups, group A – 1-cm resection and group B – 2-cm resection of the posterior part of the nasal septum. The sense of smell using the odorized markers test (OMT) and quality of life using the SNOT-22 questionnaire were evaluated preoperatively and 4 months postoperatively. Maneuverability and clarity of the operative field were evaluated for both groups. Results: A total of 42 patients, with a median age of 62 years, were included in the study. Deterioration of smell occurred in 2/ 42 (4.8%) patients, and the average value of OMT after surgery was 9 points. The average value of SNOT-22 after surgery was 12 points, and deterioration of quality of life occurred in 2/ 42 (4.8%) patients. There was no signifi cant diff erence between 1- and 2-cm septal resection in any of the monitored parameters of nasal functions. Maneuverability in the nasal cavity was signifi cantly better in the group with greater septal resection, when 18/ 21 (85.7%) patients achieved excellent values. Conclusion: There was no statistically signifi cant diff erence in postoperative results of olfaction and quality of life between the two groups. Maneuverability was signifi cantly better in the group with greater resection of the nasal septum. Transnasal endoscopic binostral approach is the method of choice for surgical removal of a pituitary adenoma, where a 2-cm resection of the nasal septum off ers better maneuverability during surgery, and at the same time does not have a higher risk of damage to nasal functions. Key words pituitary adenoma – transnasal endoscopic resection – binostral approach – nasal functions