Effect of Previous Sinonasal Surgery on Long-Term Radiographic Incidence of Sinus Disease in Patients Following Endoscopic Skull Base Surgery

Objective: The purpose of this study was to determine whether prior history of sinonasal surgery affects the incidence of long-term radiographic sinus disease after endoscopic skull base surgery.

Study Design: A retrospective review was conducted at a university medical center.

Methods: All patients that underwent a transnasal transsphenoidal endoscopic approach to the skull base with both preoperative and postoperative imaging greater than 6 months after surgery were identified. Lund-Mackay scores for CT images and an analog scoring system for MRI were used to stage all images. Change in preoperative and postoperative imaging scores were calculated and compared between patients with and without a history of a previous sinonasal intervention (i.e., septoplasty, transnasal transsphenoidal skull base surgery, or endoscopic sinus surgery).

Results: Eighty-five patients were included in the study, 37 patients without a history of prior surgery and 20 patients with a history of prior surgery. Patients with a history of prior surgery had worse mean preoperative imaging scores compared with the group undergoing primary surgery in the left maxillary sinus (difference = 0.5 vs. 0.1, P = <0.01), left frontal (difference = 0.1 vs. 0.0, P = 0.05), and left sphenoid (difference = 0.2 vs. 0.0, P = <0.01), and right sphenoid sinuses (difference = 0.3 vs. 0.0, P = <0.01). The mean postoperative changes in radiographic scoring of sinusitis differed between patients with prior surgery and those undergoing primary surgery in the right anterior ethmoids (difference = −0.05 vs., 0.3 P = 0.02), left posterior ethmoids (difference = −0.3 vs. 0.1, P = 0.01), right posterior ethmoids (difference = −0.3 vs. 0.2, P = 0.03), and left sphenoid sinus (difference = −0.05 vs. 0.2, P = 0.04). Patients with a prior sinonasal surgery showed no increase in incidence of radiographic sinusitis in the postoperative MRIs. In contrast, patients with no history of prior sinonasal surgery had worse radiographic scores in the right anterior ethmoids, right posterior ethmoids, left and right maxillary, and left and right sphenoid sinuses (P ≤ 0.01, 0.03, 0.02, <0.01, 0.02, respectively).

Conclusion: Patients with a history of sinonasal surgery show no increased incidence of radiographic evidence of sinusitis after endoscopic transnasal transsphenoidal skull base surgery.