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Asymptomatic radiographic sinonasal inflammation does not affect pituitary surgery outcomes
Author(s) -
Kuan Edward C.,
Rereddy Shruthi K.,
Patel Neil N.,
Maina Ivy W.,
Triantafillou Vasiliki,
Kohanski Michael A.,
Tong Charles C.L.,
Nabavizadeh Seyed A.,
Lee John Y.K.,
Grady M. Sean,
O'Malley Bert W.,
Palmer James N.,
Adappa Nithin D.
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27893
Subject(s) - medicine , asymptomatic , surgery , cerebrospinal fluid leak , transsphenoidal surgery , sinusitis , meningitis , complication , cerebrospinal fluid , pituitary adenoma , adenoma
Objective Chronic rhinosinusitis (CRS) is a proposed risk factor for meningitis and other intracranial complications following the endoscopic endonasal transsphenoidal approach (TSA). Some have recommended staging TSA following surgery for CRS; however, delaying TSA has important ramifications. The objective of this study is to determine whether asymptomatic sinonasal inflammation (RSNI) on preoperative computed tomography scans, without clinical CRS, is associated with postoperative complications following TSA. Methods All consecutive TSA cases performed at a single tertiary care institution from January 1, 2009, to December 31, 2017, were reviewed for patient demographics, prior surgery, presence of RSNI on preoperative computed tomography scan based on Lund‐Mackay (LM) score, intraoperative cerebrospinal fluid (CSF) leak, and postoperative complications (postoperative CSF leak, bleeding, infection). The association between preoperative RSNI and postoperative complications was analyzed via multivariate logistic regression. Results One hundred seventy‐one cases of TSA were included with mean patient age of 52.6 years, 42.7% males, 18.1% revision cases, and mean LM score of 1.9 ± 2.7. Complications were identified in 9.9% of patients at the following rates: 5.3% postoperative CSF leak, 2.9% bleeding, and 1.8% infection (all sinusitis, no episodes of meningitis). Neither total LM score nor LM score > 5 (representative of clinically significant radiographic CRS) were predictors of any postoperative complication (both P > 0.05). Age, sex, revision status, intraoperative CSF leak, and total LM score were not independent predictors of any postoperative complication on multivariate analysis (all P > 0.05). Conclusion In asymptomatic patients, radiographic evidence of sinonasal inflammation is not associated with increased risk of complications following TSA. Level of Evidence 4 Laryngoscope , 129:1545–1548, 2019