Effect of mucosal incision on postoperative olfactory function in the endoscopic transsphenoidal approach to pituitary adenoma.

OBJECTIVE: This study aims to evaluate the impact of different mucosal incision techniques during endoscopic transnasal transsphenoidal surgery on postoperative olfactory function in patients. METHODS: A retrospective analysis was conducted on clinical data of patients with pituitary adenomas, treated with endoscopic transnasal transsphenoidal surgery at the Neurosurgery Department of Liuzhou People's Hospital from December 2024 to October 2025. Patients were divided into the mucosal flap group and the submucosal group based on the nasal septum mucosal incision technique used. Postoperative olfactory dysfunction was assessed using a five-flavor odor test and an olfactory function subjective evaluation questionnaire. RESULTS: The incidence of olfactory dysfunction was 60% (46/76), 36% (27/76), and 17% (13/76) at one, three, and six months after surgery. Postoperatively, the submucosal group exhibited better recovery of olfactory function than the mucosal flap group at one month (p = 0.02) and three months (p = 0.03). However, no significant difference was observed between the two groups six months after surgery (p = 0.66). The submucosal group showed significantly greater sensitivity to foul odors at 1 and 3 months postoperatively relative to the mucosal flap group (p = 0.02 and p = 0.03, respectively). CONCLUSION: Endoscopic transnasal transsphenoidal surgery for pituitary adenomas results in short-term olfactory dysfunction. Submucosal incisions in the nasal septum mucosa facilitate faster and earlier recovery of odor recognition. In cases involving large pituitary adenomas or complex surgical procedures, the mucosal flap approach is preferred; there is no significant difference in long-term olfactory function following surgery.