Continuous Positive Airway Pressure (CPAP) Use after Endoscopic Endonasal Approach for Pituitary Adenomas: Pilot Study

Introduction: It is estimated that 10 to 30% of U.S. adults have obstructive sleep apnea (OSA) and over 8 million Americans use continuous positive airway pressure (CPAP) machines. With the increasing use of the endoscopic endonasal approach (EEA) for pituitary adenoma excision, the number of patients needing to use CPAP post-operatively will only increase. Wide variation exists in current practice regarding post-op CPAP use, with opinions ranging from clearance anywhere from 10 to 20 days after surgery. The aim of this pilot study is to assess timing, safety, and efficacy of CPAP use after EEA for pituitary adenoma surgery.

Methods: This prospective trial investigated use of CPAP on the night after surgery (POD0) in patients undergoing EEA for pituitary adenoma with no or low-flow intraoperative CSF leak. Patients were monitored in a neuro-step-down unit with every four hour neuro checks overnight. Computed tomography scan of the head obtained on POD1 and POD14 was used to assess for pneumocephalus.

Results: Five patients completed the study. All patients used CPAP the night after surgery on their normal home settings (range: 6–20 mm Hg, all <20 mm Hg). All patients had hormone secreting tumors. All had no intra-op CSF leak and were reconstructed with free mucosal graft from the middle turbinate. Skull base defect size ranged from 2.0 to 2.7 cm. All patients had no evidence of pneumocephalus on CT or altered mental status after CPAP use and thus continued use for the remainder of post-op course.

Conclusion: This pilot study is an important contribution to the evolving post-op care regimen for anterior skull base surgery. Design of a randomized trial is currently underway.

Publication History

Article published online:
01 February 2023