Potential conflict of interest: None provided.
Olfactory outcomes following endoscopic pituitary surgery with or without septal flap reconstruction: a randomized controlled trial†
Article first published online: 2 AUG 2012
Copyright © 2013 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC
International Forum of Allergy & Rhinology
Volume 3, Issue 1, pages 62–65, January 2013
How to Cite
Tam, S., Duggal, N. and Rotenberg, B. W. (2013), Olfactory outcomes following endoscopic pituitary surgery with or without septal flap reconstruction: a randomized controlled trial. International Forum of Allergy & Rhinology, 3: 62–65. doi: 10.1002/alr.21069
- Issue published online: 10 JAN 2013
- Article first published online: 2 AUG 2012
- Manuscript Accepted: 27 MAY 2012
- Manuscript Revised: 6 MAY 2012
- Manuscript Received: 1 MAR 2012
- endoscopic pituitary surgery;
- transsphenoidal surgery;
- septal flap;
- randomized controlled trial
Postoperative hyposmia and anosmia is an often overlooked complication of endoscopic pituitary surgery. Septal flaps have been utilized as a strategy for repairing and preventing postoperative cerebrospinal fluid (CSF) leaks. The olfactory impact of raising this flap for sellar reconstruction and CSF repair needs qualitative assessment. This study aims to ascertain the effect of the Hadad-Bassagasteguy (HB) flap on olfaction in endoscopic pituitary surgery.
In this randomized controlled trial, patients undergoing pituitary surgery underwent computerized randomization. Those in Group 1 all had HB flaps raised and placed for sellar floor defects. Those in Group 2 underwent reconstruction with synthetic or nonautologous materials. The University of Pennsylvania Smell Identification Test (UPSIT) was administered preoperatively and 6 months postoperatively. Results were analyzed using nonparametric tests.
Twenty subjects were enrolled, 10 in each group. Eight subjects in Group 1 vs 3 in Group 2 had intraoperative CSF leak. All were repaired intraoperatively and none required additional intervention. Preoperatively, UPSIT scores were not significantly different between groups (p = 0.62). Preoperative vs postoperative comparisons were significant for a decrease in scores in both groups postoperatively (Group 1, p < 0.001; Group 2, p < 0.001). Those undergoing HB flap reconstruction had significantly worse scores postoperatively (p = 0.001).
Endoscopic pituitary surgery results in decreased olfaction with or without deploying a septal flap. However, use of the HB flap for reconstruction can worsen hyposmia at least 6 months after surgery. Olfaction should be considered when use of the HB flap is planned. © 2013 ARS–AAOA, LLC.