Comparison of sinonasal outcomes in patients undergoing uni-nostril and bi-nostril endoscopic trans-sphenoidal excision of pituitary adenomas: a prospective study

Background Prospective studies comparing quality-of-life and olfaction in patients undergoing endoscopic uni-nostril versus bi-nostril trans-sphenoidal pituitary surgery have not been published. Methods We prospectively compared olfaction and quality-of-life at baseline and at 3-6 months follow-up using the Anterior skull base inventory – Nasal 12 (ASK-12) questionnaire, composite olfaction score and Lund – Kennedy endoscopic score (LKES) in 43 patients who underwent endoscopic excision of pituitary adenoma with either a uni-nostril (24 patients) or bi-nostril (19 patients) approach. Results Baseline data for both groups were comparable. In the uni-nostril group, ASK-12 and LKES scores were not significantly different at follow-up when compared to the pre-operative scores. In the bi-nostril group, there was a significant postoperative worsening of ASK-12 scores (mean, 3.2 vs 5.3; p = 0.04) and the LKES (mean, 2.9 vs 6.6; p = 0.01). Composite olfaction score was not significantly affected postoperatively with either approach. Nasal complications were also more in the bi-nostril group (5/18, 27.8% vs 1/23, 4.3%) but this was not statistically significant (p = 0.07). Conclusion Both approaches preserve olfactory function but the uni-nostril approach is associated with better postoperative quality-of-life and endoscopic scores and subjective olfaction outcomes. At least in short term, the postoperative morbidity is higher in the bi-nostril approach compared to the uni-nostril approach. Although preference for a particular approach is related to a surgeon’s preference, pre-operative counselling of the patients regarding sinonasal morbidity is important.