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Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients

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Abstract

The authors investigate the complications of transnasal transsphenoidal endoscopic surgery in the treatment of 301 patients with pituitary adenomas. A retrospective analysis of complications in 301 patients submitted to transsphenoidal transnasal endoscopic surgery at the General Hospital of Fortaleza, Brazil between January 1998 and December 2009. The complications were divided in two groups: anatomical (oronasofacial, sphenoid sinus, intrasellar, suprasellar and parasellar) and endocrinological complications (anterior and posterior pituitary dysfunctions). We observed a total of 81 complications (26.9%) in our series. Anatomical complications occurred in 8.97% (27 cases): 8 CSF postoperative leaks (2.6%), 6 cases (1.9%) of delayed nasal bleeding, 5 cases (1.6%) of sphenoidal sinusitis, 3 cases (0.9%) of carotid artery lesion, 2 cases of meningitis (0.6%) and one case (0.3%) of each of the uncommon following complications: intrasella-suprasella hematoma, pontine hematoma and chiasmaplexy. Endocrinological complications occurred in 17.9% (54 cases): additional postoperative anterior lobe insufficiency in 35 cases (11.6%), and postoperative diabetes insipidus in 19 cases (6.3%). In our series, 3 cases of deaths (not directly related to the procedure) were also observed. Endoscopic transsphenoidal surgery represents an effective option for the treatment of patients with pituitary tumor. Complications still occur and must be reduced as much as possible. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Additional improvement can be expected with greater experience and new technical developments.

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Authors and Affiliations

  1. Department of Neurosurgery, General Hospital of Fortaleza, Av. Eng. Santana Jr. 2977/1402, Fortaleza, CE, Brazil

    Jackson A. Gondim

  2. Department of Neurosurgery, Campinas State University, Campinas, Brazil

    Joao Paulo C. Almeida

  3. Department of Neurosurgery, Santa Casa de Belo Horizonte, Belo Horizonte, Brazil

    Lucas Alverne F. Albuquerque

  4. Department of Anesthesiology, Federal University of Ceara, Fortaleza, Brazil

    Michele Schops

  5. Department of Ear, Nose and Throat Surgery, General Hospital of Fortaleza, Sao Paulo State University, Fortaleza, CE, Brazil

    Erika Gomes

  6. Department of Endocrinology, General Hospital of Fortaleza, Fortaleza, Brazil

    Tania Ferraz & Wladia Sobreira

  7. Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, CE, Brazil

    Meissa T. Kretzmann

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  1. Jackson A. Gondim
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  2. Joao Paulo C. Almeida
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  3. Lucas Alverne F. Albuquerque
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  4. Michele Schops
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Correspondence to Jackson A. Gondim.

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Gondim, J.A., Almeida, J.P.C., Albuquerque, L.A.F. et al. Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients. Pituitary 14, 174–183 (2011). https://doi.org/10.1007/s11102-010-0280-1

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