title: Reconstructed bone chip detachment is a risk factor for sinusitis after transsphenoidal surgery.
abstract: OBJECTIVE
  Sphenoid sinusitis is a complication associated with endoscopic transsphenoidal pituitary surgery. Studies that address the relationship between methods of sellar defect reconstruction and postoperative sinusitis are rare. The purpose of this study was to investigate the incidence, the possible risk factors, and the causative pathogens of sphenoid sinusitis after endoscopic transsphenoidal pituitary surgery.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  We performed a prospective analysis of 182 patients with benign pituitary tumor who underwent endoscopic transsphenoidal pituitary surgery and sellar defect reconstruction with bone chip, from July 2008 through July 2011. All patients were followed up with nasal endoscopy for at least 6 weeks.
  
  
  RESULTS
  Fifty-seven (31.3%) patients developed postoperative sphenoid sinusitis. Comparing the sinusitis and nonsinusitis groups, we found that bone chip detachment was a significant risk factor for postoperative sinusitis, with a relative risk of 2.86 (64.1% vs. 22.4%). The most common pathogens present in cases of postoperative sinusitis were methicillin-sensitive Staphylococcus aureus, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus.
  
  
  CONCLUSIONS
  Regular follow-up with nasal endoscopy can prevent delayed diagnosis of postoperative sphenoid sinusitis. Culture-directed antibiotics with aggressive endoscopic debridement are an effective treatment for these patients. An optimal reconstruction strategy should be further developed to reduce bone chip detachment and secondary sinusitis.
authors.affiliation: Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yao-Wen
authors.initials: YW
authors.lastname: Hsu
authors.forename: Ching-Yin
authors.initials: CY
authors.lastname: Ho
authors.forename: Yu-Shu
authors.initials: YS
authors.lastname: Yen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery*; D011446:Prospective Studies; D012307:Risk Factors; D012658:Sella Turcica / Q000473:pathology / Q000601:surgery*; D013101:Sphenoid Sinus; D015524:Sphenoid Sinusitis / Q000453:epidemiology* / Q000209:etiology* / Q000382:microbiology; D055815:Young Adult
keywords: Sphenoid sinusitis; pituitary surgery; sellar reconstruction