Incidence of Sphenoid Sinus Mucoceles after Endoscopic Transsphenoidal Approach with Sphenoid Obliteration

Objective: Sphenoid sinus mucocele is a rare complication of transsphenoidal surgery and can present clinically many years after the initial surgery. Although the formation of sphenoid sinus mucocele has been previously described in the literature as case reports, there is no information demonstrating the incidence of sphenoid sinus mucocele after sphenoid obliteration in a large series. This study aims to determine the incidence of sphenoid sinus mucocele formation and other postoperative complications following transsphenoidal surgery with fat obliteration.

Methods: A retrospective review was performed of patients who underwent sphenoid obliteration with fat after Transsphenoidal approach for pituitary adenoma by two surgeons at our institution from 2001 to 2003. Follow-up records up to 2015 were obtained for these patients. Data collected included demographics, operation performed, sphenoid sinus obliteration method, reconstruction method, follow-up period, postoperative complications, recurrence and residual disease.

Results: Of the 95 patients who underwent Transsphenoidal approach and sphenoid obliteration with fat, 27 patients developed postoperative complications. None had sphenoid sinus mucocele formation. Recurrence of disease occurred in 11.6% of patients. Residual disease was present in 7.4% of patients. Complications included sinusitis, hematoma, hyponatremia, acromegaly and postoperative need for the placement of a ventriculoperitoneal shunt.

Conclusion: Sphenoid sinus mucocele formation is a rare complication following transsphenoidal surgery with fat obliteration with an estimated incidence of less than 1.1%. Further studies with more cases are needed to accurately establish the incidence.