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J Neurol Surg B Skull Base 2023; 84(03): 255-265
DOI: 10.1055/a-1838-5897
Original Article

Complications in Endoscopic Endonasal Pituitary Adenoma Surgery: An Institution Experience in 310 Patients

Mohamad Namvar
1   Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
2   Department of Neurological Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
,
Arad Iranmehr 
1   Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
2   Department of Neurological Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
,
Mohamad Reza Fathi
1   Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
2   Department of Neurological Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
,
Seyed Mousa Sadrhosseini
3   Department of Otolaryngology-Head and Neck Surgery, Imam Khomeini Hospital Complex, Tehran, Iran
,
Azin Tabari
3   Department of Otolaryngology-Head and Neck Surgery, Imam Khomeini Hospital Complex, Tehran, Iran
,
Noushin Shirzad
4   Department of Endocrinology and Metabolism, Tehran University of Medical Sciences, Tehran, Iran
,
Mehdi Zeinalizadeh
1   Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
2   Department of Neurological Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Abstract

Objective Endoscopic endonasal approaches (EEAs) have shown excellent results for majority of hypophyseal tumors. The aim of this study was to evaluate and report the complications of EEA in patients with pituitary adenoma (PA) who underwent surgery between 2013 and 2018.

Methods We performed a retrospective review of 310 consecutive patients/325 procedures with PA treated with an EEA from May 2013 to January 2018. Minor complications including transient diabetes insipidus (DI) or new anterior pituitary hormone insufficiency in one axis and major complications including CSF leakage, hematoma needing reoperation, vascular damage, brain infection, new pan-hypopituitarism permanent DI, new visual impairment, neurological deficits, and mortality were recorded.

Results We encountered 58 complications in 310 patients (18.7%) and 325 procedures (17.7%). Minor complications were 43 (13.9 and 13.2%) in 310 patients and in 325 procedures, respectively; whereas, major complications were 28 (9 and 8.6%, respectively). Total complications were associated with diameter group 2 (>30 mm), diaphragm sella violation, suprasellar extension, parasellar involvement, nonfunctional secretory type, and intraoperative arachnoid tearing.

Conclusion EEA can be considered as a safe surgical treatment which has acceptable complications in the management of PAs.

Keywords

pituitary adenoma - complication - CSF leakage


Publication History

Received: 07 January 2022

Accepted: 22 April 2022

Accepted Manuscript online:
28 April 2022

Article published online:
05 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Gondim JA, Schops M, de Almeida JP. et al. Endoscopic endonasal transsphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary center. Pituitary 2010; 13 (01) 68-77
    CrossrefPubMedGoogle Scholar
  • 2 Berker M, Hazer DB, Yücel T. et al. Complications of endoscopic surgery of the pituitary adenomas: analysis of 570 patients and review of the literature. Pituitary 2012; 15 (03) 288-300
    CrossrefPubMedGoogle Scholar
  • 3 Lobatto DJ, de Vries F, Zamanipoor Najafabadi AH. et al. Preoperative risk factors for postoperative complications in endoscopic pituitary surgery: a systematic review. Pituitary 2018; 21 (01) 84-97
    CrossrefPubMedGoogle Scholar
  • 4 Frank G, Pasquini E, Farneti G. et al. The endoscopic versus the traditional approach in pituitary surgery. Neuroendocrinology 2006; 83 (3-4): 240-248
    CrossrefPubMedGoogle Scholar
  • 5 Tabaee A, Anand VK, Barrón Y. et al. Endoscopic pituitary surgery: a systematic review and meta-analysis. J Neurosurg 2009; 111 (03) 545-554
    CrossrefPubMedGoogle Scholar
  • 6 Bajpai A, Kabra M, Menon PS. Central diabetes insipidus: clinical profile and factors indicating organic etiology in children. Indian Pediatr 2008; 45 (06) 463-468
    PubMedGoogle Scholar
  • 7 Rajaratnam S, Seshadri MS, Chandy MJ, Rajshekhar V. Hydrocortisone dose and postoperative diabetes insipidus in patients undergoing transsphenoidal pituitary surgery: a prospective randomized controlled study. Br J Neurosurg 2003; 17 (05) 437-442
    CrossrefPubMedGoogle Scholar
  • 8 Kristof RA, Rother M, Neuloh G, Klingmüller D. Incidence, clinical manifestations, and course of water and electrolyte metabolism disturbances following transsphenoidal pituitary adenoma surgery: a prospective observational study. J Neurosurg 2009; 111 (03) 555-562
    CrossrefPubMedGoogle Scholar
  • 9 Hensen J, Henig A, Fahlbusch R, Meyer M, Boehnert M, Buchfelder M. Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary adenomas. Clin Endocrinol (Oxf) 1999; 50 (04) 431-439
    CrossrefPubMedGoogle Scholar
  • 10 De Divitiis E, Cappabianca P, Cavallo L. Endoscopic Endonasal Transsphenoidal Approach to the Sellar Region. Springer; 2003: 91-130
    CrossrefGoogle Scholar
  • 11 D'Haens J, Van Rompaey K, Stadnik T, Haentjens P, Poppe K, Velkeniers B. Fully endoscopic transsphenoidal surgery for functioning pituitary adenomas: a retrospective comparison with traditional transsphenoidal microsurgery in the same institution. Surg Neurol 2009; 72 (04) 336-340
    CrossrefPubMedGoogle Scholar
  • 12 Gondim JA, Almeida JP, Albuquerque LA. et al. Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients. Pituitary 2011; 14 (02) 174-183
    CrossrefPubMedGoogle Scholar
  • 13 Lofrese G, Vigo V, Rigante M. et al. Learning curve of endoscopic pituitary surgery: Experience of a neurosurgery/ENT collaboration. J Clin Neurosci 2018; 47: 299-303
    CrossrefPubMedGoogle Scholar
  • 14 Halvorsen H, Ramm-Pettersen J, Josefsen R. et al. Surgical complications after transsphenoidal microscopic and endoscopic surgery for pituitary adenoma: a consecutive series of 506 procedures. Acta Neurochir (Wien) 2014; 156 (03) 441-449
    CrossrefPubMedGoogle Scholar
  • 15 Cappabianca P, Cavallo LM, Colao A, de Divitiis E. Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 2002; 97 (02) 293-298
    CrossrefPubMedGoogle Scholar
  • 16 Charalampaki P, Ayyad A, Kockro RA, Perneczky A. Surgical complications after endoscopic transsphenoidal pituitary surgery. J Clin Neurosci 2009; 16 (06) 786-789
    CrossrefPubMedGoogle Scholar
  • 17 Hardy J. Transsphenoidal hypophysectomy. J Neurosurg 1971; 34 (04) 582-594
    CrossrefPubMedGoogle Scholar
  • 18 Kabil MS, Eby JB, Shahinian HK. Fully endoscopic endonasal vs. transseptal transsphenoidal pituitary surgery. Minim Invasive Neurosurg 2005; 48 (06) 348-354
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Zhou T, Wei SB, Meng XH, Xu BN. [Pure endoscopic endonasal transsphenoidal approach for 375 pituitary adenomas]. Zhonghua Wai Ke Za Zhi 2010; 48 (19) 1443-1446
    PubMedGoogle Scholar
  • 20 Laws Jr ER, Thapar K. Pituitary surgery. Endocrinol Metab Clin North Am 1999; 28 (01) 119-131
    CrossrefPubMedGoogle Scholar
  • 21 Alsaleh S, Albakr A, Alromaih S, Alatar A, Alroqi AS, Ajlan A. Expanded transnasal approaches to the skull base in the Middle East: where do we stand?. Ann Saudi Med 2020; 40 (02) 94-104
    CrossrefPubMedGoogle Scholar
  • 22 Rivera-Serrano CM, Snyderman CH, Gardner P. et al. Nasoseptal “rescue” flap: a novel modification of the nasoseptal flap technique for pituitary surgery. Laryngoscope 2011; 121 (05) 990-993
    CrossrefPubMedGoogle Scholar
  • 23 Zhang Y, Wang Z, Liu Y. et al. Endoscopic transsphenoidal treatment of pituitary adenomas. Neurol Res 2008; 30 (06) 581-586
    CrossrefPubMedGoogle Scholar
  • 24 Shibao S, Toda M, Tomita T, Ogawa K, Yoshida K. Analysis of the bacterial flora in the nasal cavity and the sphenoid sinus mucosa in patients operated on with an endoscopic endonasal transsphenoidal approach. Neurol Med Chir (Tokyo) 2014; 54: 1009-1013
    CrossrefPubMedGoogle Scholar
  • 25 Kono Y, Prevedello DM, Snyderman CH. et al. One thousand endoscopic skull base surgical procedures demystifying the infection potential: incidence and description of postoperative meningitis and brain abscesses. Infect Control Hosp Epidemiol 2011; 32 (01) 77-83
    CrossrefPubMedGoogle Scholar
  • 26 Iranmehr A, Esmaeilnia M, Afshari K, Sadrehosseini SM, Tabari A, Jouibari MF, Zeinalizadeh M. Surgical outcomes of endoscopic endonasal surgery in 29 patients with craniopharyngioma. J Neurol Surg B Skull Base 2020; 82 (04) 401-409
    PubMedGoogle Scholar
  • 27 Murad MH, Fernández-Balsells MM, Barwise A. et al. Outcomes of surgical treatment for nonfunctioning pituitary adenomas: a systematic review and meta-analysis. Clin Endocrinol (Oxf) 2010; 73 (06) 777-791
    CrossrefPubMedGoogle Scholar
  • 28 Ciric I, Ragin A, Baumgartner C, Pierce D. Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 1997; 40 (02) 225-236 , discussion 236–237
    CrossrefPubMedGoogle Scholar