Remission, complications, and overall survival in transsphenoidal pituitary surgery—a Swedish single-center experience of 578 patients

Abstract

Background Surgical treatment of pituitary lesions causing hormonal overproduction or mass effect is standard procedure. There are few reports on the results and complications related to these surgeries from Northern Europe. Our aim was to evaluate the outcome and complications of a single tertiary surgical center over more than a decade. Methods This was a retrospective study on all patients that underwent pituitary surgery from 1st of January 2005 to 31st of December 2017. The analysis included type of lesion, surgical method, pre- and postoperative need for hormonal substitution, hormonal outcome, complications to surgery, survival, need for revision surgery, or stereotactic radiation. Appropriate statistical analyses were made to evaluate surgical results, complications, and survival. Results Five hundred seventy-eight patients were included in the study. Remission was achieved in 58% of patients with GH-producing and 94% of ACTH-releasing adenomas. Sixty-six percent had no preoperative hormonal substitution compared to 39% postoperatively. Rhinosinusitis (10%) was the most commonly reported postoperative complication followed by leakage of cerebrospinal fluid (8%) and meningitis (4%). Standardized mortality rate for the study population was higher (p = 0.18) when compared to the general population. Conclusion Our results regarding remission rates and complications are in comparison with previous studies. Surgery of pituitary lesion can be considered a safe and efficient surgery. We noted lower rates of CSF leakage in the later part of the study period and believe that this, in part, was an effect by the introduction of a multidisciplinary surgical skull base team and increased surgical experience.

The effect of preoperative TSH levels on perioperative complications in patients undergoing pituitary surgery

“…The second most common complication was rhinorrhea in 51 patients (8.4%). Meningitis (4%) and sepsis (2%) were identified as other common complications [ 10 ]. In the study conducted by Chowdhury et al with 149 patients, the most common complication was rhinorrhea (40%), followed by diabetes insipidus at 14.8%.…”

Multidisciplinary Team Care in Pituitary Tumours

“…Other studies showed that post-operative follow-up by an endocrinologist reduced the risk of 30-day readmission after surgery [ 38 , 39 ]. Cerebrospinal fluid leakage rates after transsphenoidal surgery have decreased since the introduction of a multidisciplinary surgical skull base team in a high-volume Swedish centre [ 40 ]. Pituitary MDT benefits have also been highlighted in a series of four women with sellar lesions during pregnancy [ 41 ].…”

“…In 29 of 60 (48.4%) German neurosurgical centres, otorhinolaryngologists are never involved in pituitary surgeries, whereas in only 8 centres (13.3%) surgeries are always performed together with an otorhinolaryngologist [ 91 ]. Nevertheless, the collaboration between pituitary neurosurgeons and otorhinolaryngologists during endonasal and other skull base surgical approaches is of extreme value, allowing higher tumour resection rates and fewer post-operative complications, particularly cerebrospinal fluid leakages [ 39 , 40 , 92 , 93 ].…”

“…While such direct costs are easier to calculate based on the time spent and number of physicians involved in such meetings, the indirect financial benefits and cost-effectiveness for high-quality decision making and more efficacious management of pituitary tumours are more difficult to assess, and remain poorly described [ 2 , 110 ]. Recent studies showed that the creation of a Pituitary MDT reduced inpatient hospital days [ 2 , 37 ], decreased post-operative complications [ 2 , 40 ], lowered the risk of readmission after surgery [ 39 ], and reduced costs in laboratory studies [ 36 ], while at the same time improving clinical outcomes [ 36 , 37 , 42 , 43 ]. Multidisciplinary management of patients with functioning tumours achieves higher rates of biochemical cure [ 51 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ], allowing significant savings in terms of their long-term management associated with the costs of medications to treat hormone excess in persistent or recurrent disease.…”