Sinonasal Complications of Combined Transseptal–Transnasal and Bilateral Transnasal Approaches for Endoscopic Endonasal Transsphenoidal Pituitary Surgery

Background: The endoscopic combined transseptal–transnasal technique for pituitary adenoma excision is notable for enhanced postoperative functional outcomes. Our study compared the incidence of anterior nasal septal perforation and the resulting sinonasal complications between this method and the bilateral transnasal approach. Methods: Using a retrospective cohort from a pre-eminent tertiary referral center, we analyzed 141 cases of endoscopic endonasal transsphenoidal surgery performed between March 2018 and May 2023. Outcomes for the transseptal–transnasal group (n = 71) and the conventional bilateral transnasal group (n = 70) were compared. Nasal endoscopy and computed tomography were used to assess anterior nasal septal perforation. Functional outcomes were assessed preoperatively and at 6 months postoperatively using the Connecticut Chemosensory Clinical Research Center test, Cross-Cultural Smell Identification Test, Sino-Nasal Outcome Test-22, and nasal obstruction symptom evaluation. Results: The transseptal–transnasal approach exhibited reduced rates of postoperative ear fullness (P < 0.001), along with fewer subjective complaints of smell/taste loss (P = 0.022) and thick nasal discharge (P = 0.008), compared to the conventional approach. However, objective smell test results were not significantly different between the 2 approaches (P = 0.243 and P = 0.454 for Connecticut Chemosensory Clinical Research Center and Cross-Cultural Smell Identification Test, respectively). Additionally, although statistically insignificant, a higher incidence of anterior septal perforation was observed with the transseptal–transnasal approach (P = 0.067). Conclusions: For the surgical treatment of pituitary adenomas, the transseptal–transnasal approach offers several advantages over the bilateral transnasal method, particularly in reducing postoperative complications. However, this technique requires careful attention for preventing the occurrence of anterior septal perforation.