Abstract：
BACKGROUND: This is the largest study in North America investigating olfactory outcomes after pituitary surgery to date.
OBJECTIVE: Characterize factors associated with subjective olfactory dysfunction (OD) and worsened sinonasal quality-of-life (QOL) after endoscopic TSA.
METHODS: Patients undergoing primary TSA for secreting and non-secreting pituitary adenomas between 2017 and 2021 with pre- and post-operative SNOT-22 scores were included. Subjective OD was determined by the smell/taste dysfunction question on the SNOT-22 (smell-SNOT).
RESULTS: 159 patients with pre- and post-operative SNOT-22 scores were included. Average total SNOT-22 scores worsened from pre-operative (16.91 ± 16.91) to POM1 (25.15 ± 20.83, P < .001), with no difference from pre-operative (16.40 ± 15.88) to POM6 (16.27 ± 17.92, P = .936) or pre-operative (13.63 ± 13.54) to POM12 (12.60 ± 16.45, P = .651). Average smell-SNOT scores worsened from pre-operative (0.40 ± 1.27) to POM1 (2.09 ± 2.01, P < .001), and pre-operative (0.46 ± 1.29) to POM6 (1.13 ± 2.45, P = .002), with no difference from pre-operative (0.40 ± 1.07) to POM12 (0.71 ± 1.32, P = .100). Female gender had a 0.9-point (95% CI 0.1 to 1.6) P = .021, increase in smell-SNOT at POM1, resolving by POM6 (0.1 [-0.9 to 1.1], P = .800) and POM12 (0.0 [-1.0 to 0.9], P = .942). Septoplasty with tunnel approach had a 1.1 [0.2 to 2.0] out of 5-point (P = .023) increase in smell-SNOT at POM1, resolving by POM6 (0.2 [-1.1 to 1.6], P = .764) and POM12 (0.4 [-0.9 to 1.6], P = .567). Female gender had a 9.5 (4.0 to 15.1)-point (P = .001) increase in SNOT-22 scores at POM1, resolving by POM6 (3.4 [-3.0 to 9.8], P = .292) and POM12 (6.4 [-5.4 to 18.2], P = .276). Intra-operative CSF leak had an 8.6 [2.1 to 15.1]-point (P = .009) increase in SNOT-22 scores at POM1, resolving by POM6 (5.4 [-1.7 to 12.5], P = .135), and POM12 (1.1 [-12.9 to 15.1], P = .873).
CONCLUSIONS: Changes in subjective olfaction and sinonasal QOL after TSA may be associated with gender, operative approach, and intra-operative CSF leak, resolving 6-12 months post-operatively.
OBJECTIVE: Characterize factors associated with subjective olfactory dysfunction (OD) and worsened sinonasal quality-of-life (QOL) after endoscopic TSA.
METHODS: Patients undergoing primary TSA for secreting and non-secreting pituitary adenomas between 2017 and 2021 with pre- and post-operative SNOT-22 scores were included. Subjective OD was determined by the smell/taste dysfunction question on the SNOT-22 (smell-SNOT).
RESULTS: 159 patients with pre- and post-operative SNOT-22 scores were included. Average total SNOT-22 scores worsened from pre-operative (16.91 ± 16.91) to POM1 (25.15 ± 20.83, P < .001), with no difference from pre-operative (16.40 ± 15.88) to POM6 (16.27 ± 17.92, P = .936) or pre-operative (13.63 ± 13.54) to POM12 (12.60 ± 16.45, P = .651). Average smell-SNOT scores worsened from pre-operative (0.40 ± 1.27) to POM1 (2.09 ± 2.01, P < .001), and pre-operative (0.46 ± 1.29) to POM6 (1.13 ± 2.45, P = .002), with no difference from pre-operative (0.40 ± 1.07) to POM12 (0.71 ± 1.32, P = .100). Female gender had a 0.9-point (95% CI 0.1 to 1.6) P = .021, increase in smell-SNOT at POM1, resolving by POM6 (0.1 [-0.9 to 1.1], P = .800) and POM12 (0.0 [-1.0 to 0.9], P = .942). Septoplasty with tunnel approach had a 1.1 [0.2 to 2.0] out of 5-point (P = .023) increase in smell-SNOT at POM1, resolving by POM6 (0.2 [-1.1 to 1.6], P = .764) and POM12 (0.4 [-0.9 to 1.6], P = .567). Female gender had a 9.5 (4.0 to 15.1)-point (P = .001) increase in SNOT-22 scores at POM1, resolving by POM6 (3.4 [-3.0 to 9.8], P = .292) and POM12 (6.4 [-5.4 to 18.2], P = .276). Intra-operative CSF leak had an 8.6 [2.1 to 15.1]-point (P = .009) increase in SNOT-22 scores at POM1, resolving by POM6 (5.4 [-1.7 to 12.5], P = .135), and POM12 (1.1 [-12.9 to 15.1], P = .873).
CONCLUSIONS: Changes in subjective olfaction and sinonasal QOL after TSA may be associated with gender, operative approach, and intra-operative CSF leak, resolving 6-12 months post-operatively.
摘要：
背景：这是迄今为止北美最大的研究垂体手术后嗅觉结局的研究。
目的：表征与鼻内镜下TSA术后主观嗅觉功能障碍（OD）和鼻窦生活质量（QOL）恶化相关的因素。
方法：纳入了2017年至2021年因分泌性和非分泌性垂体腺瘤而接受原发性TSA的患者，术前和术后的SNOT-22评分。主观OD由SNOT-22(气味-SNOT)上的气味/味道功能障碍问题确定。
结果：纳入159例患者术前和术后SNOT-22评分。SNOT-22平均总分从术前(16.91±16.91)恶化至POM1(25.15±20.83,P<.001),术前（16.40±15.88）与POM6（16.27±17.92，P=.936）或术前（13.63±13.54）与POM12（12.60±16.45，P=.651）无差异。平均气味-SNOT评分从术前(0.40±1.27)恶化至POM1(2.09±2.01,P<.001),术前（0.46±1.29）至POM6（1.13±2.45，P=0.002），术前（0.40±1.07）与POM12（0.71±1.32，P=.100）无差异。女性为0.9分（95％CI0.1至1.6）P=.021，在POM1时嗅觉NOT增加，通过POM6解决（0.1[-0.9至1.1]，P=.800）和POM12（0.0[-1.0至0.9]，P=.942）。用隧道法进行的中隔成形术在POM1的5点（P=.023）中增加了1.1[0.2至2.0]，通过POM6解决（0.2[-1.1至1.6]，P=.764）和POM12（0.4[-0.9至1.6]，P=.567）。女性在POM1时的Snot-22得分增加了9.5（4.0至15.1）点（P=.001），由POM6解决（3.4[-3.0至9.8]，P=.292）和POM12（6.4[-5.4至18.2]，P=.276）。术中脑脊液渗漏在POM1时SNOT-22评分增加8.6[2.1至15.1]（P=.009），由POM6解决（5.4[-1.7至12.5]，P=.135），和POM12（1.1[-12.9至15.1]，P=.873）。
结论：TSA后主观嗅觉和鼻窦生活质量的变化可能与性别有关，手术入路,术中脑脊液漏,术后6-12个月解决。
目的：表征与鼻内镜下TSA术后主观嗅觉功能障碍（OD）和鼻窦生活质量（QOL）恶化相关的因素。
方法：纳入了2017年至2021年因分泌性和非分泌性垂体腺瘤而接受原发性TSA的患者，术前和术后的SNOT-22评分。主观OD由SNOT-22(气味-SNOT)上的气味/味道功能障碍问题确定。
结果：纳入159例患者术前和术后SNOT-22评分。SNOT-22平均总分从术前(16.91±16.91)恶化至POM1(25.15±20.83,P<.001),术前（16.40±15.88）与POM6（16.27±17.92，P=.936）或术前（13.63±13.54）与POM12（12.60±16.45，P=.651）无差异。平均气味-SNOT评分从术前(0.40±1.27)恶化至POM1(2.09±2.01,P<.001),术前（0.46±1.29）至POM6（1.13±2.45，P=0.002），术前（0.40±1.07）与POM12（0.71±1.32，P=.100）无差异。女性为0.9分（95％CI0.1至1.6）P=.021，在POM1时嗅觉NOT增加，通过POM6解决（0.1[-0.9至1.1]，P=.800）和POM12（0.0[-1.0至0.9]，P=.942）。用隧道法进行的中隔成形术在POM1的5点（P=.023）中增加了1.1[0.2至2.0]，通过POM6解决（0.2[-1.1至1.6]，P=.764）和POM12（0.4[-0.9至1.6]，P=.567）。女性在POM1时的Snot-22得分增加了9.5（4.0至15.1）点（P=.001），由POM6解决（3.4[-3.0至9.8]，P=.292）和POM12（6.4[-5.4至18.2]，P=.276）。术中脑脊液渗漏在POM1时SNOT-22评分增加8.6[2.1至15.1]（P=.009），由POM6解决（5.4[-1.7至12.5]，P=.135），和POM12（1.1[-12.9至15.1]，P=.873）。
结论：TSA后主观嗅觉和鼻窦生活质量的变化可能与性别有关，手术入路,术中脑脊液漏,术后6-12个月解决。
