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

J Neurol Surg B Skull Base, 2023 · DOI: https://doi.org/10.1055/a-1838-5897 · Published: July 5, 2022

Simple Explanation

This study evaluates the complications associated with endoscopic endonasal approach (EEA) for pituitary adenoma surgery performed between 2013 and 2018. The study reviewed 310 patients who underwent EEA for pituitary adenomas, recording minor (transient diabetes insipidus or single anterior pituitary hormone insufficiency) and major complications (CSF leak, hematoma, vascular damage, infection, pan-hypopituitarism, permanent DI, vision issues, neurological deficits, mortality). The results showed that while EEA is generally safe, certain factors like tumor size, location, and surgical technique can influence the complication rate.

Study Duration

May 2013 to January 2018

Participants

310 consecutive patients/325 procedures with pituitary adenoma

Evidence Level

Not specified

Key Findings

1
The overall complication rate was 18.7% in patients and 17.7% in procedures, with minor complications at 13.9% and 13.2% respectively, and major complications at 9% and 8.6% respectively.
2
Total complications were associated with tumor diameter >30 mm, diaphragm sella violation, suprasellar extension, parasellar involvement, nonfunctional secretory type, and intraoperative arachnoid tearing.
3
Posterior pituitary insufficiency (DI) occurred in 14.1% of patients, with 10.6% being temporary and 3.5% permanent, related to pituitary apoplexy and intraoperative arachnoid tearing.

Research Summary

This retrospective study analyzed complications in 310 patients undergoing endoscopic endonasal approach (EEA) for pituitary adenoma surgery between 2013 and 2018, identifying both minor and major complications and their associated factors. The study found an overall complication rate of 17.7%, with specific factors such as tumor size, location, and surgical technique significantly influencing the occurrence of complications like CSF leakage, diabetes insipidus, and visual impairment. The authors conclude that while EEA is a safe surgical treatment for pituitary adenomas, careful consideration of risk factors and surgical techniques are crucial for minimizing complications.

Practical Implications

Patient Selection

Careful patient selection and preoperative assessment are crucial to identify risk factors such as large tumor size, suprasellar extension, and parasellar involvement.

Surgical Technique

Meticulous surgical technique, including careful handling of the arachnoid layer and appropriate dural reconstruction, can minimize the risk of CSF leakage and other complications.

Postoperative Management

Close postoperative monitoring and management of potential complications such as diabetes insipidus, hyponatremia, and visual impairment are essential for optimizing patient outcomes.

Study Limitations

1
Low number of incidents for some uncommon complications limits precise analysis.
2
Nasal complications were not included in the study.
3
The learning curve was assessed based on the first and second halves of the patient cohort.

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