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Pre-operative ENT evaluation for endoscopic endonasal/transsphenoidal pituitary surgery.

HPI

History of transsphenoidal approach in 2001 (Puerto Rico) for pituitary macroadenoma, complicated intra-operatively by CSF leak repaired with abdominal fat graft and postoperative diabetes insipidus (DI). No postoperative CSF rhinorrhea at that time. Since then, she has undergone serial MRI surveillance for regrowth. Latest MRI demonstrates recurrent/Residual pituitary adenoma and neurosurgery has recommended repeat transsphenoidal resection.

She presents today for rhinologic clearance. She denies nasal obstruction, rhinorrhea, PND, hyposmia/anosmia, facial pain/pressure, epistaxis, or sinus infections. No dyspnea or mouth-breathing.

Pertinent History

• Prior surgeries: Endonasal transsphenoidal (2001) with fat-graft skull base reconstruction.

• Complications: DI post-op in 2001 (resolved/managed per endocrine; current status per neurosurgery/endocrinology).

• Allergies/

Assessment

Patient with prior endonasal transsphenoidal surgery (2001) complicated by intra-op CSF leak repaired with abdominal fat graft and post-op DI, now with imaging-proven recurrent/residual pituitary adenoma. She has no current rhinologic symptoms and normal anterior nasal exam, and today’s CTA head reveals no sinonasal or vascular issues that would preclude a repeat endoscopic endonasal/transsphenoidal approach. From an otolaryngology–rhinology perspective, she is cleared for surgery, with counseling provided regarding risks unique to re-do skull base procedures (CSF leak, epistaxis, septal/mucosal injury, synechiae, infection, olfactory change) and coordination with neurosurgery and endocrinology for peri-operative DI monitoring.

Plan

• Proceed to Surgery: Cleared for endoscopic endonasal/transsphenoidal resection in coordination with neurosurgery.