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Reconstructed bone chip detachment is a risk factor for sinusitis after transsphenoidal surgery

Authors

  • Yao-Wen Hsu MD,

    1. Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan
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  • Ching-Yin Ho MD, PhD,

    Corresponding author
    1. Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan
    • Send correspondence to Ching-Yin Ho, MD, Department of Otolaryngology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd, Taipei 11217, Taiwan. E-mail: cyho@vghtpe.gov.tw

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  • Yu-Shu Yen MD

    1. Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

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.

Study Design

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.

Level of Evidence

2b. Laryngoscope, 124:57–61, 2014

Ancillary