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Postoperative complications after endoscope-assisted transsphenoidal surgery for pituitary adenomas: a case series, systematic review, and meta-analysis of the literature

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A Correction to this article was published on 15 April 2022

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Abstract

Purpose

Endoscope-assisted transsphenoidal surgery over the last few years has led to more radical excision of pituitary adenomas (PAs) with a low complication rate. Systematic registration of complications by experienced surgical teams could help to improve this technique while ameliorating the patients’ quality of life.

Materials and methods

One hundred ten endoscopic procedures were performed in 94 patients with PAs (37 functional) by the same neurosurgical team of a tertiary center during the period 2014–2019. Post-surgical complications were analyzed and compared with data published during the last 5 years in the PubMed and Cochrane databases by performing a systematic review and meta-analysis of the literature.

Results

The overall complication rate in our series was 23.4%. Diabetes insipidus (DI) and intraoperative cerebrospinal fluid (CSF) leakage were the commonest complications (12.8%), followed by postoperative hypopituitarism (9.2%) and hematoma (8.5%) during the follow-up of 2.15 ± 1.4 years. Syndrome of inappropriate antidiuretic hormone secretion, meningitis, deep vein thrombosis, and hyposmia were rare (< 3%). Postoperative hypopituitarism was significantly associated with incidence of hematoma. No statistically significant association was found between PAs Hardy and Knosp scale grading or between patients’ characteristics with the occurrence of postoperative complications. Our meta-analysis including nine studies found no significant differences comparing the complications of endoscopic versus microscopic surgery.

Conclusion

The endoscopic approach is safe when performed by experienced surgical teams. CSF leakage and DI were the commonest complications in our series; however, confirmation by larger studies is required. Meta-analysis showed no statistically significant differences in complication rates comparing endoscopic versus microscopic surgery.

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Data availability

The data that support the findings of this study are available from the corresponding author [P.S.].

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Authors and Affiliations

  1. Department of Neurosurgery, Thriasio General Hospital of Elefsina, G. Gennimata Ave, 19200, Magoúla, Attiki, Athens, Greece

    Petros Stefanidis

  2. Department of Pathology, Evaggelismos Hospital, Athens, Greece

    Georgios Kyriakopoulos

  3. 1st Department of Internal Medicine, Unit of Endocrinology, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Fani Athanasouli, Chrysoula Mytareli & Anna Angelousi

  4. Department of Interventional Cardiology, Metropolitan Hospital, Athens, Greece

    Georgios Τzanis

  5. Department of Neurosurgery, Evaggelismos Hospital/National and Kapodistrian University of Athens, Athens, Greece

    Stefanos Korfias

  6. 1st Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece

    Stamatios Theocharis

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Contributions

Conceptualization: SP and AA. Methodology: KS and TS. Data curation: SP. Formal analysis and investigation: MC and TG. Meta-analysis: AF. Writing-original draft and preparation: SP and KG. Writing-review and editing: SP and AA. Supervision and final approval: KS, TS, and AA.

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Correspondence to Petros Stefanidis.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The Bioethics Committee of the Medical School of National and Kapodistrian University of Athens, Athens, Greece (No 142/27.06.2019) approved the study.

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Informed consent was obtained from all individual participants included in the study.

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Additional informed consent was obtained from all individual participants for whom identification information is included in this article.

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Stefanidis, P., Kyriakopoulos, G., Athanasouli, F. et al. Postoperative complications after endoscope-assisted transsphenoidal surgery for pituitary adenomas: a case series, systematic review, and meta-analysis of the literature. Hormones 21, 487–499 (2022). https://doi.org/10.1007/s42000-022-00362-1

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