Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients

Abstract

The authors investigate the complications of transnasal transsphenoidal endoscopic surgery in the treatment of 301 patients with pituitary adenomas. A retrospective analysis of complications in 301 patients submitted to transsphenoidal transnasal endoscopic surgery at the General Hospital of Fortaleza, Brazil between January 1998 and December 2009. The complications were divided in two groups: anatomical (oronasofacial, sphenoid sinus, intrasellar, suprasellar and parasellar) and endocrinological complications (anterior and posterior pituitary dysfunctions). We observed a total of 81 complications (26.9%) in our series. Anatomical complications occurred in 8.97% (27 cases): 8 CSF postoperative leaks (2.6%), 6 cases (1.9%) of delayed nasal bleeding, 5 cases (1.6%) of sphenoidal sinusitis, 3 cases (0.9%) of carotid artery lesion, 2 cases of meningitis (0.6%) and one case (0.3%) of each of the uncommon following complications: intrasella-suprasella hematoma, pontine hematoma and chiasmaplexy. Endocrinological complications occurred in 17.9% (54 cases): additional postoperative anterior lobe insufficiency in 35 cases (11.6%), and postoperative diabetes insipidus in 19 cases (6.3%). In our series, 3 cases of deaths (not directly related to the procedure) were also observed. Endoscopic transsphenoidal surgery represents an effective option for the treatment of patients with pituitary tumor. Complications still occur and must be reduced as much as possible. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Additional improvement can be expected with greater experience and new technical developments.

Effectiveness of Endoscopic Endonasal Transsphenoidal Surgery Using a Neuronavigation: Clinical Results of 178 Pituitary Adenomas

“…The reported complication rates of TSS are 9.1%, 23.4% and 22.1% [1,14,16], which are far higher than ours. Damage to the carotid artery leads to serious complications ( Table 6).…”

“…However, most macroadenomas with Knosp grade 4 could not be completely removed because the tumor body had extended laterally in most of them ( Table 2). Jackson et al reported a GTR rate of 79.3% and a removal rate including subtotal resection of 89% under traditional TSS [16]. Our removal rate including subtotal resection was 82%.…”

“…Damage to the carotid artery leads to serious complications ( Table 6). Cappabianca et al and Gondim et al reported carotid artery injury rates of 0.7%-0.9% [14,16]. Preventing such damage might thus be one advantage of endoscopic TSS with navigation [17].…”

Endoscopic Endonasal Skull Base Surgery: Current State of the Art and Future Trends

“…Postoperative infection risk is comparable to intracranial open skull base surgery with a rate reaching 1.8% of patients. Risk factors of meningitis are mainly peroperative CSF leaks and postoperative external ventricular or lumbar drains (Gondim et al, 2010, Kono et al, 2010.…”

Prospective validation of a patient-reported nasal quality-of-life tool for endonasal skull base surgery: The Anterior Skull Base Nasal Inventory-12

“…6,7,15,24 Central to the effort of determining the impact of rhinological morbidity on QOL is the development of a validated nasal morbidity instrument constructed specifically for the population undergoing endonasal skull base surgery.…”