Morbidity following Endoscopic Surgery of the Sella

Objective: Endoscopic transsphenoidal surgery is increasingly common for accessing tumors of the anterior skull base. The aim of this study is to describe the sinonasal outcomes of endoscopic transsphenoidal pituitary surgery by a single otolaryngologist in conjunction with a team of experienced neurosurgeons.

Methods: A total of 434 consecutive patients underwent endoscopic transsphenoidal removal of pituitary tumors and other tumors of the anterior skull base between April 2006 and November 2013. Sinonasal outcomes including epistaxis, CSF leak, sinusitis, nasal obstruction, anosmia, and the number of wound debridements were recorded. In addition, operative time, tumor histology, and mortality rates were recorded.

Results: About 52.1% of patients were male. The mean age at surgery was 51.4 years. Tumors included pituitary adenomas (73.3%; 57.8% hormone positive, 15.9% null cell), Rathke cleft cysts (6.7%), other anterior skull base tumors (6.7%), and 12.9% were not identifiable on histology. Overall, 3.1% of patients who underwent sellar reconstruction had a post-op CSF leak, compared with 10% of those who did not undergo sellar reconstruction (p = 0.048, chi-square test with Yates correction). Nasal obstruction was the most common complication with 51.2% of patients having some degree of temporary obstruction at a post-op visit. Patients underwent an average of 1.7 sellar debridements over their post-op course. A total of 42 patients (9.7%) had one or more episodes of epistaxis. Of the 42 patients, 17 (40.5%) required intervention; 7 were cauterized with silver nitrate, 5 returned to the OR for control of bleeding, 2 underwent embolization, 2 had rapid rhino's placed, and 1 was treated with Floseal. Other complications included sinusitis (8.5%), septal osteomyelitis (3.2%), anosmia (1.7%), meningitis (0.7%), sellar hematoma (0.7%), sphenoid sinus mucocele (0.5%), DVT (0.5%), PE (0.5%), septal ulcer (0.2%), and septal perforation (0.2%).

Conclusion: The endoscopic transsphenoidal approach is becoming more popular for accessing sellar and parasellar tumors. The most common sinonasal complications are epistaxis, CSF leaks, sinusitis, and septal osteomyelitis. Postoperative CSF leaks are more common when the sella is not reconstructed intraoperatively. In our experience, the endoscopic transsphenoidal approach is well tolerated with low sinonasal complication rates.

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