Complications of Endoscopic Endonasal Skull Base Surgery for Sellar Pathology—An Institutional Experience

Background: Endoscopic endonasal surgery is the preferred approach for most sellar pathologies and with the advent of nasoseptal flap reconstruction, major complications have been effectively countered. We present our institutional experience in the management of sellar pathologies with the endoscopic endonasal approach.

Methods: Patients who underwent endoscopic endonasal skull base surgery for sellar pathology between 2012 and 2018 were retrospectively evaluated. Complications reviewed were divided into major and minor. Major complications included new-onset and continuing CSF leak and meningitis. Minor complications included long-standing crust formation, synechia, epistaxis, septal perforation, sinusitis, and anosmia.

Results: Fifty-nine patients with managed with EES for their sellar pathologies. The mean age was 56.4 years (± 8.9) and M:F = 26:33. The most common pathology was pituitary macroadenoma, seen in 42 (71%) patients. Intraoperative CSF leak was observed in 19 patients; however, postop leak was noted only in four patients. Preop and postop lumbar drainage placement was required in seven patients. DI was noted in 14 patients and managed effectively. Minor complications were noted in eight (12%) patients requiring local treatment and observation.

Conclusions: EES is an extremely effective approach for sellar tumors. While it is associated with a low rate of major complications, minor complications are frequent, but require only local (nasal) treatment and conservative management. CSF leaks can be effectively managed with temporary lumbar drain placement