Objective: The primary aim of this report is to determine the number and incidence of complications of transsphenoidal surgery in our experience and to review the results reported in the literature. Material and methods: Between 1990 and 1999, 963 transsphenoidal procedures, for a pituitary adenoma, were performed at our institution: 293 non-secreting adenomas, 274 GH-secreting adenomas, 133 prolactinomas, 239 ACTHsecreting adenomas, and 24 TSH-omas. The complications of transsphenoidal surgery may be divided into endocrine complications, visual complications, carotid artery injury, sellar hematoma, CSF rhinorrhea, major intracranial complications, minor intracranial complications, and anesthetic and perioperative general medical complications. Results: The endocrine complications, in patients with normal preoperative pituitary function were panhypopituitarism in 0.9%, permanent damage to one or two pituitary endocrine axes in 3.1%; in patients with preoperative endocrine deficit where the incidence of impairment of pituitary function was 0.5%. Transient diabetes insipidus occurred in 4%, and permanent diabetes insipidus in 1.9%. The incidence of visual defect in patients with preoperative normal visual function was 0.3%, the impairment in patients with preoperative defect was 1.1%. Transient cranial nerve paralysis (third and sixth) occurred in 0.4%. In our experience vascular injury of the carotid artery in the cavernous sinus never occurred. Sellar hematoma, requiring reoperation, occurred in only one patient (0.1%). The incidence of CSF rhinorrhea in our experience was 1.5%, but only one case required reoperation; all the other cases were treated with lumbar CSF drainage. The incidence of major complications was 1% (3 strokes, 1 intracerebral hematoma, 4 meningitis, 2 cases of cerebral vein thrombosis). The incidence of minor intracranial complications was 0.6% (3 cases of epistaxis, 1 mucocele, 1 sinusitis, 1 SIADH). The incidence of anesthetic and perioperative general medical complications was 1.7% (4 cases of respiratory or urinary infection, 3 cases of deep-vein thrombosis, 3 cases of pulmonary embolism, 2 cases of surgical anemia requiring transfusion, 1 kidney colic, 1 biliary colic, 1 glottis edema). The mortality rate was 0.2% (2 cases for pulmonary embolism). Conclusion: The transsphenoidal approach is the procedure of choice in the treatment of most pituitary adenomas. Complications are relatively uncommon, averaging approximately 4% in the literature; the mortality rate was reported between 0% and 1%. In our experience the morbidity was 1.1% and mortality 0.2%.
|Number of pages||1|
|Issue number||SUPPL. 2|
|Publication status||Published - 2001|
ASJC Scopus subject areas
- Clinical Neurology