Preoperative risk factors for postoperative complications in endoscopic pituitary surgery: a systematic review

Abstract

BackgroundThe ability to preoperatively predict postoperative complication risks is valuable for individual counseling and (post)operative planning, e.g. to select low-risk patients eligible for short stay surgery or those with higher risks requiring special attention. These risks however, are not well established in pituitary surgery.MethodsWe conducted a systematic review of associations between preoperative characteristics and postoperative complications of endoscopic transsphenoidal surgery according to the PRISMA guidelines. Risk of bias was assessed through the QUIPS tool.ResultsIn total 23 articles were included, containing 5491 patients (96% pituitary adenoma). There was a wide variety regarding the nature and number of risk factors, definitions, measurement and statistics employed, and overall quality of mainly retrospective studies was low. Consistent significant associations were older age for complications in general, and intraventricular extension for cerebrospinal fluid (CSF) leaks. Associations identified in some but not all studies were younger age, increased BMI, female gender, and learning curve for CSF leaks; increased tumor size for complications in general; and Rathke’s cleft cysts for diabetes insipidus. Mortality (incidence rate 1%) was not addressed as a risk factor.ConclusionBased on current literature, of low to medium quality, it is not possible to comprehensively quantify risk factors for complications. Nevertheless, older age and intraventricular extension were associated with increased postoperative complications. Future research should aim at prospective data collection, reporting of outcomes, and uniformity of definitions. Only then a proper risk analysis can be performed for endoscopic pituitary surgery.Electronic supplementary materialThe online version of this article (doi:10.1007/s11102-017-0839-1) contains supplementary material, which is available to authorized users.

Infectious Complications of Expanded Endoscopic Transsphenoidal Surgery: A Retrospective Cohort Analysis of 100 Cases

“…Lobatto et al 13 also reported that only one out of five series in their review demonstrated an association between tumor size and CSF leaks. [35][36][37][38][39][40] In our cohort of patients, tumor volume was not found to be a significant predictor of CSF leaks or meningitis, although the tumor volume of the patients with CSF leaks trended higher (12.03 AE 12.96 mL) than patients who did not develop a CSF leak (10.7 AE 15.7 mL).…”

“…A few studies inconsistently report preoperative risk factors that are associated with postoperative meningitis, such as diabetes mellitus and intraventricular extension of the tumor. [13][14][15] Here, we analyze patients from a single institution undergoing expanded endonasal surgeries for many pathologies, in an effort to identify perioperative factors that may predispose patients to CSF leakage and meningitis.…”

Predictive Factors, 30-Day Clinical Outcomes, and Costs Associated with Cerebrospinal Fluid Leak in Pituitary Adenoma Resection

“…7,8 As discussed by Lobatto et al identifying patients with risk factors for complications like CSF leak is imperative for appropriate consideration of preoperative planning and timing of the operation, patient counseling, consultation or referral to a center of excellence, alternative treatments, and postoperative management such as short versus long stay. 9 Some literature has identified risk factors for postoperative CSF leak. Nishioka et al suggest that prior transsphenoidal surgery and prior radiotherapy to the skull are risk factors, while Dlouhy et al and Ivan et al found that increased body mass index (BMI) was correlated with CSF leak.…”

“…[10][11][12] Lobatto et al conducted a systematic review on general endoscopic pituitary surgical outcomes and identified 14 studies that examined risk factors for CSF leaks, specifically. 9 Only interventricular extension was consistently associated with CSF leak, although extension was defined in different ways in different studies. Some studies have identified younger age, 13,14 increased BMI, 11,13,14 female gender, 13,14 increased tumor size, 15 and surgeons' learning 16 curve as less consistent associations with CSF leaks.…”

An Unexpected Complication of Transsphenoidal Resection of Pituitary Adenoma

“…The most reported postoperative complications of transsphenoidal surgery are postoperative cerebrospinal fluid leak, epistaxis, bleeding, visual deterioration, and meningitis. 2,3 In this article, we reported an unexpected complication of transsphenoidal surgery consisting of an aberrant surgical way through the posterolateral wall of the sphenoidal sinus in place of the posterosuperior wall. Thus, surgeon has removed the petrous apex parts, that is, cochlea, osseous, and membranous labyrinths leading to a right deafness and a facial palsy.…”