Impact of posterior septectomy on olfaction in endoscopic endonasal transsphenoidal surgery

PLoS One. 2025 Jan 2;20(1):e0316263. doi: 10.1371/journal.pone.0316263. eCollection 2025.

Abstract

Background: Endoscopic endonasal transsphenoidal surgery is widely used to resect pituitary adenomas, yet its impact on olfactory function after resection of the posterosuperior nasal septum remains a concern. To optimize surgical techniques to preserve olfactory function, it is essential to understand the relationship between the extent of septal resection and olfactory outcomes.

Methods: This retrospective study analyzed 295 patients who underwent pituitary adenoma surgery. The extent of nasal septum resection was quantified and its impact on olfactory function was assessed using the Cross-Cultural Smell Identification Test (CCSIT), Sino-Nasal Outcome Test-22 (SNOT-22), and a Visual Analog Scale (VAS) for olfactory loss. Preoperative and 6-month postoperative scores were compared to evaluate changes in olfactory function.

Results: There was a significant correlation between larger septal resections and greater reductions in CCSIT scores, indicating a decline in olfactory function. Furthermore, patients with more extensive septal resections reported increased discomfort and olfactory loss, as evidenced by higher SNOT-22 and VAS scores. These findings highlight the importance of the nasal septum in maintaining laminar airflow and its role in olfactory function.

Conclusion: Study underscores the adverse effects of extensive posterior septectomy on olfactory outcomes. Minimizing the extent of septal resection may help preserve olfactory function, suggesting a need for surgical strategies that maintain septum integrity to reduce the risk of postoperative olfactory impairment.

MeSH terms

  • Adenoma / surgery
  • Adult
  • Aged
  • Endoscopy* / adverse effects
  • Endoscopy* / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nasal Septum* / surgery
  • Olfaction Disorders / etiology
  • Pituitary Neoplasms* / surgery
  • Retrospective Studies
  • Smell* / physiology
  • Treatment Outcome
  • Young Adult

Grants and funding

This study was supported by a grant of the E.N.T. Fund of the Catholic University of Korea made in the program year of 2023, the National Research Foundation of Korea grant (RS-2023-00209494), and the Korean Fund for Regenerative Medicine grant (23C0121L1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.