Predictors of Short-Term Outcomes following Endoscopic Pituitary Surgery

Background: Refinement of endoscopic pituitary surgery requires an understanding of the impact of demographic and surgical variables on outcomes including gross tumor removal, hormone resolution, and complications.

Methods: A prospective database of patients undergoing endoscopic pituitary surgery by the senior authors between 2004 to 2006 was analyzed. Multivariate logistic regression and ANOVA models were used to explore variables for association with outcomes.

Results: There were 57 patients included in this series: 37% secreting adenomas and 63% nonsecreting adenomas.The mean duration of surgery was 177 minutes with longer surgery in patients with larger tumor size (p = 0.03) and presentation with visual symptoms (p = 0.02) in univariate analyses.The mean duration of hospitalization was 4 days and was longer in patients with larger tumors (p = 0.0005) and in patients who experienced complications (p = 0.001).Gross tumor removal was achieved in 89% of cases with 5 cases of subtotal resection due to cavernous sinus extension and a single intraoperative complication of hemorrhage.Tumor size correlated with extent of tumor removal with an almost 3-fold decrease in complete tumor removal for every 1 cm increase in tumor size (p = 0.047). Of the 24 patients with visual symptoms prior to surgery, 22 (92%) reported improvement after the procedure. Postoperative complications included CSF leak (5%), which resolved with lumbar drainage, and permanent diabetes insipidus (4%).There were no significant predictors of overall complications although a trend towards increased complications was noted with secreting adenomas, a history of prior surgery, and longer operative times.

Conclusions: The early favorable results following endoscopic pituitary surgery support its ongoing development.Our findings highlight the challenges and learning curve associated with larger tumors and operative complications.