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 to 6 months follow-up using the Anterior Skull Base Nasal Inventory-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 a 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 with the preoperative 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 with the uni-nostril approach. Although preference for a particular approach is related to a surgeon's preference, preoperative counselling of the patients regarding sinonasal morbidity is important.