Incidence of Radiologic Evidence of Sinusitis following Endoscopic Pituitary Surgery: A Multicenter Study

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Background: Endoscopic endonasal skull base surgery has emerged as a credible alternative to open procedures for surgical treatment of benign and malignant sinonasal and skull base lesions. As in sinus surgery, skull base surgery may cause crusting and posterior rhinorrhea, especially when a nasoseptal flap is necessary for skull base reconstruction. Postoperative radiological sinonasal findings have been reported previously with no clear correlation to intraoperative decision-making. As in open surgery, endoscopic surgery is not standardized and there is variability in intervention to assist exposure and skull base repair. These modifications, including middle turbinate resection, nasoseptal flap, fat graft, and maxillary antrostomy have the potential for nasal morbidity Methods: A retrospective analysis of all patients who underwent endoscopic endonasal skull base surgery for pituitary lesions at two major referral centers. Data on demographic, clinical, and pathological features were collected, and pre- and postoperative imaging studies (CT and MRI) were reviewed and scored according to the Lund-Mackay (LM) scoring system. Results: The study included 183 patients. Radiolographic evidence of sinusitis was observed in 30 patients (LM score >4) on postoperative imaging studies. Patients who underwent middle turbinectomy or nasoseptal flap were found to have statistically significant higher LM on follow-up imaging. Nasoseptal flap was found to be associated with an average increase in LM score of 1.67 points and middle turbinectomy with an average increase of 2.21 points. There was no correlation between tumor size and findings compatible with sinusitis on postoperative imaging. Conclusion: The findings of the present study suggest that endoscopic endonasal skull base surgery is associated with radiological evidence of sinusitis. Nasoseptal flap reconstruction and middle turbinectomy were strongly associated with radiographic sinusitis and should be judiciously performed during surgery. Clinical correlation is needed for further recommendations. Publication History Article published online: 07 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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