Sphenoid Sinus Osteitis Following Endoscopic Transsphenoidal Surgery

Pituitary tumors account for approximately 15% of primary intracranial neoplasms, with many cases diagnosed incidentally. Transsphenoidal surgery,particularly the endoscopic approach, remains theprimary treatment for pituitary tumors despite the advancement of non-surgical treatments. A rare yetsignificant complication following this surgery is sphenoid sinus osteitis, aninfectious condition characterized by inflammation of the bone. This study aimsto report the incidence and risk factors of sphenoid sinus osteitis followingendoscopic transsphenoidal pituitary tumor resection.MethodsA retrospective analysis was conducted on 1,908 patients who underwentendoscopic transsphenoidal surgery for sellar base tumors between September2021 and November 2024. CT imaging were used to evaluate bony involvementin the sphenoid sinus, with severity categorized based on bone thickness: mild(<3 mm), moderate (4–5 mm), and severe (>5 mm). The presence of osteitis wasassessed based on radiographic evidence of neo-osteogenesis.ResultsOf the 1,908 patients, 12 (0.0063%) were diagnosed with sphenoid sinus osteitisduring routine postoperative follow-ups. The cohort consisted of 10 women and2 men with a mean age of 38 years. The most common presenting symptomswere cacosmia, nasal blockage, and headache. 83% of patients had isolatedsphenoid sinus involvement, while there mainder had additional ethmoid sinusinvolvement. The most significant risk factor identified was a history of endoscopic transsphenoidal surgery, commonly performed for pituitary adenomaresection.ConclusionsEndoscopic transsphenoidal surgery remains the primary treatment for pituitarytumors due to its minimally invasive nature and shorter recovery times. However, postoperative complications such as sphenoid sinus osteitis may arise. Thepathophysiology of osteitis following pituitary tumor resection remains poorlyunderstood, and although surgical intervention is recommended for severecases, the role of long-term antibiotic therapy remains unclear. This study,although limited by a small sample size and single-institution data, is the first toevaluate sphenoid sinus osteitis in this context, providing valuable insight into arare postoperative complication