Asymptomatic radiographic sinonasal inflammation does not affect pituitary surgery outcomes
Edward C. Kuan MD, MBA  Shruthi K. Rereddy MD  Neil N. Patel BS  Ivy W. Maina BA  Vasiliki Triantafillou BA  Michael A. Kohanski MD, PhD  Charles C.L. Tong MD … See all authors
First published: 05 March 2019 https://doi.org/10.1002/lary.27893
Editor's Note: This Manuscript was accepted for publication on February 5, 2019.
Presented as an oral presentation at the 2018 American Rhinologic Society Annual Meeting in Atlanta, Georgia, U.S.A., October 6, 2018.
The authors report no conflicts of interest or relevant financial disclosures.

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Abstract
Objective
Chronic rhinosinusitis (CRS) is a proposed risk factor for meningitis and other intracranial complications following the endoscopic endonasal transsphenoidal approach (TSA). Some have recommended staging TSA following surgery for CRS; however, delaying TSA has important ramifications. The objective of this study is to determine whether asymptomatic sinonasal inflammation (RSNI) on preoperative computed tomography scans, without clinical CRS, is associated with postoperative complications following TSA.

Methods
All consecutive TSA cases performed at a single tertiary care institution from January 1, 2009, to December 31, 2017, were reviewed for patient demographics, prior surgery, presence of RSNI on preoperative computed tomography scan based on Lund‐Mackay (LM) score, intraoperative cerebrospinal fluid (CSF) leak, and postoperative complications (postoperative CSF leak, bleeding, infection). The association between preoperative RSNI and postoperative complications was analyzed via multivariate logistic regression.

Results
One hundred seventy‐one cases of TSA were included with mean patient age of 52.6 years, 42.7% males, 18.1% revision cases, and mean LM score of 1.9 ± 2.7. Complications were identified in 9.9% of patients at the following rates: 5.3% postoperative CSF leak, 2.9% bleeding, and 1.8% infection (all sinusitis, no episodes of meningitis). Neither total LM score nor LM score > 5 (representative of clinically significant radiographic CRS) were predictors of any postoperative complication (both P > 0.05). Age, sex, revision status, intraoperative CSF leak, and total LM score were not independent predictors of any postoperative complication on multivariate analysis (all P > 0.05).

Conclusion
In asymptomatic patients, radiographic evidence of sinonasal inflammation is not associated with increased risk of complications following TSA.

Level of Evidence
4

Laryngoscope, 129:1545–1548, 2019