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  • “Minor” Complications with Transsphenoidal Surgery: Often Ignored but Always Relevant

    Final Number:

    Garni Barkhoudarian MD; Kenneth Delosreyes MD; Sarah C. Jernigan MD; Daniel F. Kelly MD; Edward R Laws MD, FACS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Transsphenoidal surgery is the primary approach for sellar and parasellar lesions. These operations are associated with many uncommon but significant risks such as carotid artery injury, visual loss, CSF rhinorrhea, meningitis and pituitary failure. There are numerous frequently encountered but rarely reported minor complications that are individually rare but cumulatively common, each of which can affect the patient’s operative experience.

    Methods: All patients who had undergone endonasal transsphenoidal surgery at our institution were retrospectively evaluated. Major complications such as stroke, vascular injury, pituitary failure, vision loss, epistaxis, DVT/PE, MI, coma and death were excluded. Minor complications were classified and identified in this patient population.

    Results: 580 patients had transsphenoidal surgery at this institution, 34 (5.9%) underwent a microscopic approach, 488 (84.1%) underwent an endoscopic approach and 58 (10.0%) had a hybrid approach. 62 (10.7%) patients were noted to have a major, non-endocrine complication. 65 (11.1%) patients were noted to have a minor complication that affected their post-operative recovery. These included endocrine related issues, positioning issues, sino-nasal and oral complications, anesthesia related problems, fat graft site complications and endoscope visualization difficulties. Minor endocrine complications included transient diabetes insipidus (34), in-hospital SIADH (8) and steroid induced psychosis (2). Sinonasal complications include mucocoeles, sinusitis and synechia. Other relatively frequent findings include positioning related neck pain (4) and fat graft site complications (2).

    Conclusions: The peri-operative and post-operative management of transsphenoidal patients can significantly be affected by major and minor complications alike. Attention to every detail of the patients’ care can help minimize these cumulatively common issues.

    Patient Care: This study can help improve the prevention and management of minor complications that frequently affect patients who undergo endoscopic or microscopic transsphenoidal pituitary surgery

    Learning Objectives: By the conclusion of this session, participants should be able to 1) Identify common minor complications of transsphenoidal pituitary surgery, 2) Understand the impact of these complications on the post-operative care of the patient and 3) Understand techniques to minimize these minor complications.


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