title: Efficacy of controlling rhinosinusitis on the prevention of complications in pituitary surgery with transsphenoidal approach.
abstract: OBJECTIVE
  The microscopic transcolumellar transseptal transsphenoidal approach (TSA) is the one of the most widely used methods for the surgical treatment of sellar and parasellar lesions. But nasal and paranasal sinus inflammation is the relative contraindications of TSA. This study was performed to investigate the results of pre TSA treatment options according to the degree of nasal and paranasal sinus inflammation on the paranasal sinus computed tomography scan (PNS CT).
  
  
  METHODS
  From January 2005 to September 2010, 145 consecutive patients underwent operation of pituitary lesions through the TSA. The preoperative CT images for these patients were reviewed, and 26 patients were identified with sinus opacification on PNS CT. We then analyzed presenting symptoms, physical and endoscopic examination, Lund-Mackay score on PNS CT and preoperative management of the sinus problem retrospectively.
  
  
  RESULTS
  Twenty-six patients had sinus opacification on PNS CT. Eight patients had the symptoms of sinusitis corresponding to PNS CT finding, so they had therapeutic antibiotics, and had TSA after symptomatic improvement. Three patients had the symptoms of sinusitis and sinus opacification with mean Lund-Mackay score of 5.33, so they underwent endoscopic sinus surgery first, and they got TSA a few months after. One patient underwent endoscopic sinus surgery and TSA simultaneously. No patient had a serious complication including intracranial infection.
  
  
  CONCLUSIONS
  TSA is a relatively safe technique, but intracranial complication after surgery may be fatal. Therefore rigorous evaluation and management is mandatory. It is especially important to treat rhinosinusitis issues preoperatively. Our preliminary data may be helpful to evaluate and manage the paranasal sinus inflammation before TSA.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Dong-A University, Busan, Republic of Korea. Electronic address: doncamel@dau.ac.kr.
authors.forename: Woo Yong
authors.initials: WY
authors.lastname: Bae
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Dong-A University, Busan, Republic of Korea.
authors.forename: So Hyang
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Dong-A University, Busan, Republic of Korea.
authors.forename: Min Young
authors.initials: MY
authors.lastname: Kang
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Dong-A University, Busan, Republic of Korea.
authors.forename: Tae Kyung
authors.initials: TK
authors.lastname: Koh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D000075202:Contraindications; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012220:Rhinitis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D018942:Macrolides
keywords: Endoscopic sinus surgery; Pituitary tumor; Rhinosinusitis; Transsphenoidal approach