Endonasal transsphenoidal surgery: the patient's perspective-survey results from 259 patients.
BACKGROUND
Patient impressions remain an important yet often overlooked aspect of surgical success. Herein we present postoperative questionnaire results in patients after a standard direct endonasal approach, an extended suprasellar endonasal approach, and a reoperative transsphenoidal surgery for tumor removal with the operating microscope.


METHODS
From July 1998 through April 2005, of 452 patients undergoing endonasal surgery, 346 were sent questionnaires, and of these, 259 (75%) completed them. Nasal packing was placed for 24 hours in the first 95 patients but not in the last 357.


RESULTS
Overall, 73% of patients reported a better experience than expected and 8% worse than expected. A worse than expected overall experience was noted in 15% of patients with nasal packing compared with 5% of patients without packing (P = .001). Of patients with preoperative headache, 49% resolved, 34% somewhat resolved, and 5% worsened. The frequency of rhinological complaints declined from 2 weeks to 3 months postsurgery (P < .001); by 3 months or more postsurgery, 67% to 87% of patients had no rhinological complaints and 1% to 2% had severe complaints. Of 30 patients with prior sublabial surgery, the endonasal procedure afforded easier recovery (87%), less pain (80%), better nasal airflow (79%), and a shorter hospital stay (median 3 vs 5 days) (P < .001). Of 28 patients with complications, the severity of rhinological complaints was similar to those without complications except this subgroup reported greater loss of sense of smell 3 months after surgery (P < .001).


CONCLUSIONS
Rhinological recovery is typically rapid and relatively complete after direct endonasal transsphenoidal surgery using both standard and extended suprasellar approaches. Compared with the sublabial route, the endonasal approach is associated with less pain, better nasal airflow, and a shorter hospital stay.
Division of Neurosurgery, University of California at Los Angeles School of Medicine, 200 UCLA Medical Plaza, Los Angeles, CA 90095-7182, USA.
Joshua R
JR
Dusick
Felice
F
Esposito
Carlos A
CA
Mattozo
Charlene
C
Chaloner
David L
DL
McArthur
Daniel F
DF
Kelly
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003919:Diabetes Insipidus / Q000209:etiology / Q000517:prevention & control; D004844:Epistaxis / Q000209:etiology / Q000517:prevention & control; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000033:anatomy & histology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods* / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D012658:Sella Turcica / Q000033:anatomy & histology / Q000601:surgery*; D013100:Sphenoid Bone / Q000473:pathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome