Invagination of the Sphenoid Sinus Mucosa after Endoscopic Endonasal Transsphenoidal Approach and Its Significance

• Published in: PloS one 2016-09, Vol.11 (9), p.e0162836-e0162836
• Main Authors: Kim, Do Hyun, Hong, Yong-Kil, Jeun, Sin-Soo, Park, Jae-Sung, Jung, Ki Hwan, Kim, Soo Whan, Cho, Jin Hee, Park, Yong Jin, Kang, Yun Jin, Kim, Sung Won
• Format: Article
• Language: English
• Subjects: Adenoma - surgery; Adult; Aged; Arachnoid; Atmospheric density; Biology and Life Sciences; CAT scans; Computed tomography; Endoscopes; Endoscopy; Endoscopy - adverse effects; Endoscopy - methods; Female; Headache; Health aspects; Humans; Intracranial Pressure; Male; Medicine; Medicine and Health Sciences; Middle Aged; Mucosa; Nasal Cavity - physiopathology; Neurosurgery; Otolaryngology; Paranasal sinus; Patients; Pituitary Neoplasms - surgery; Postoperative Complications - diagnostic imaging; Postoperative Complications - physiopathology; Pressure; Pressure changes; Research and Analysis Methods; Retrospective Studies; Review boards; Sella Turcica - diagnostic imaging; Sella Turcica - physiopathology; Sella Turcica - surgery; Sinus; Sinuses; Sphenoid Sinus - diagnostic imaging; Sphenoid Sinus - physiopathology; Sphenoid Sinus - surgery; Surgery; Tomography, X-Ray Computed; Tumors; Visual Analog Scale
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0162836

To describe the clinical features of invagination of the sphenoid sinus mucosa (ISM) and compare them with other similar cases using a visual analog scale (VAS) to assess the various nasal symptoms and to discuss its clinical significance and means of prevention. Retrospective chart review at a tertiary referral center. Between 2010 and 2015, 8 patients who had undergone EETSA surgery displayed postoperative ISM. The comparison group consisted of 147 patients who underwent the same surgical procedures and were diagnosed with the same diseases. Pre- or postoperative paranasal sinus computed tomography (PNS CT) and VAS were performed and subsequently analyzed. The clinical features of ISM of the sphenoid sinus showed sellar floor invagination and regenerated inverted ingrowing sphenoid mucosa on endoscopic imaging. PNS CT also showed a bony defect and invaginated air densities at the sellar turcica. Pre- and postoperative VAS scores revealed that the ISM group had much less of an improvement in headaches after surgery than that of the comparison group (p = 0.049). ISM may occur because of a change in pressure, sphenoid mucosal status, or arachnoid membrane status. Moreover, ISM is related to improvements in headaches. Therefore, EETSA patients should avoid activities that cause rapid pressure changes during the healing process. In addition, sellar reconstruction that is resistant to physical pressure changes should be mandated despite the absence of an intraoperative CSF leak.