Key points
- A single-centre retrospective study with 41 participants was
conducted.
- An endoscopic modified transseptal bi-nostril approach was used for
pituitary surgery.
- The procedure protects the bilateral turbinates and olfactory
epithelium by providing access to the sphenoid sinus by a transseptal
approach via the left nasal cavity and by the olfactory cleft approach
via the right nasal cavity without resecting any turbinate.
- The postoperative jet stream olfactometer test values of the right,
left, and bilateral nasal cavities were markedly improved after
surgery.
- No recurrence or olfactory dysfunction was observed.
INTRODUCTION
Currently, the olfactory dysfunction rate associated with pituitary
surgery has been decreasing with improved approaches to access the
pituitary region. The rate after a sub-microscopic transsphenoidal
approach is approximately 39.7%,2–9 whereas those
associated with the use of a nasoseptal flap (NSF) under endoscopy and
bilateral rescue flaps are approximately 14.4%1,
10-13 and 0−12%,4, 6, 7, 14, 15 respectively.
However, even with the use of bilateral rescue flaps, olfactory
dysfunction after the endoscopic endonasal transsphenoidal approach
(EETSA) remains a risk, attributed to the mechanical irritation to the
nasal septal mucosa and superior turbinate that occurs when securing the
corridor creation and visual field.6 Therefore, a less
stressful approach to the nasal septal mucosa and turbinates is needed.
There are also concerns about the olfactory testing methods used after
EETSA. Since most olfactory testing in the literature relies on
bilateral nasal olfactory tests, the test results may depend on the
results of the good side. Therefore, after EETSA surgery, it is unclear
whether the olfactory sense is preserved on one or both side(s).
Therefore, the assessment of olfactory function needs to be performed on
a unilateral basis because unilateral olfactory impairment influences
the ability to identify and discriminate olfaction16and is more likely to result in overall olfactory impairment associated
with increasing age.17
In our institution, we use the endoscopic modified transseptal
bi-nostril approach to minimize turbinate and olfactory mucosal invasion
and ensure every turbinate’s and bilateral olfaction’s preservation.
Herein, we investigated the results of olfactory function and changes in
the right and left nostrils before and after surgery for cases using
this approach, and reported them with statistical analysis.
MATERIALS AND METHODS