Introduction: Some authors report fewer major complications in endoscopic transsphenoidal pituitary surgery than microscopic surgery. Few have reported their experience with non-pituitary lesions and many inconsistently report endocrine complications. We report the major endocrine and surgical complications after pure endoscopic transsphenoidal surgery in a consecutive series of 420 cases by a single surgeon.
Methods: A retrospective review of all patients who underwent endoscopic endonasal transsphenoidal surgery from April 1, 2008 to August 1, 2012 at the Brigham and Women’s Hospital was performed. Extended transsphenoidal approaches were included. We excluded cases with operating microscope use. We recorded all basic demographic and clinical characteristics as well as details of major complications. Basic statistical analysis and multivariate logistic regression was performed.
Results: There were 102 major complications (in 83 patients) among the 420 purely endoscopic transsphenoidal cases (24.2%). The mean age was 47.6 years old (10-80), and 57% were female. Pituitary adenomas accounted for 304 (72.4%) cases, and 82 (19.5%) were recurrences. Endocrine dysfunction occurred in 50 (11.9%) patients, with 4.1% developing new central adrenal insufficiency, 2.9 % permanent diabetes insipidus, and 5.0 % symptomatic hyponatremia. “Approach” related adverse events occurred in 22 (5.2%) patients: 3.8 % had epistaxis and 1.5 % sinusitis. Other complications included CSF leak (2.4%), vascular injury (0.5%), cranial nerve palsy (1.4%), and meningitis (1.0%). Extended transsphenoidal cases (p=0.003) and non-adenomas (p=0.01) were associated with higher risk of post-operative complication. Multivariate logistic regression revealed that an extended approach was the only independent risk factor for a major complication, OR 4.51 (CI 1.49 – 13.68).
Conclusions: Though endoscopic transsphenoidal surgery has its advantages, major complications still occur. Strategies to reduce complications are discussed. Recognition of these complications helps inform patients and better prepare surgeons, particularly in extended cases.
Patient Care: This study helps the neurosurgeon anticipate complications in endoscopic transsphenoidal surgery and be better prepared for managing them and avoiding them, thereby improving patient care and outcome. The neurosurgeon can also better disclose and inform the pre-operative patient of the inherent risks to endoscopic transsphenoidal surgery.
Learning Objectives: By the conclusion of this session, participants should be able to: 1)Describe the major complications of endoscopic transsphenoidal surgery 2)Describe risk factors for major complications in endoscopic transsphenoidal surgery, 3)Understand strategies and be more prepared for minimizing major complications in endoscopic transsphenoidal surgery 4)Inform patients of the likelihood of a major complications prior to surgery