Transseptal Transsphenoidal Approach to Hypophysectomy: Comparisons of Sinonasal Quality of Life and Complications

Background: The transsphenoidal approach to pituitary and sellar lesions has evolved drastically with the use of endoscopy. The most common approaches today, incorporating posterior septectomy, as well as a great deal, of mucosal manipulation that have been associated in the literature with high rates of sinonasal complaints such as crusting. Though the transseptal approach had been described more than a century ago, the adaptation of the technique using endoscopy as well as the resulting outcomes and complications have not been well-described.

Methods: A retrospective chart review was performed of patients who underwent primary endoscopic, transseptal, transphenoidal hypophysectomy at Rhode Island Hospital between April 2015 and December 2018. Rates of sinonasal complaints and complications, including nasal crusting, congestion, epistaxis, septal perforations, septal hematomas, synechiae, impaired olfaction, dysesthesia, and postoperative sinusitis were collected and compared with those found in the literature.

Results: Forty-five patients underwent transsphenoidal hypophysectomy for a primary pituitary lesion over the 3.5 year study period. In our cohort, a single patient had nasal crusting and no patients were found to have hematoma, septal perforation, synechiae, or require debridement. Epistaxis occurred at a rate of 10.5% postoperatively, but always resolved without surgical management.

Conclusions: The transseptal transsphenoidal approach to pituitary lesions provides a safe option to surgeons and patients who prioritize the minimization of postoperative complaints and complications.