Avoiding complications in endoscopic trans-sphenoidal surgery for pituitary adenoma: A beginner's perspective

Abstract

Introduction: We aimed to analyze the difficulties and complications experienced while as a beginner in endoscopic transnasal transsphenoidal approach for pituitary adenomas. Materials and Methods: We retrospectively analyzed 83 cases done from June 2016 to August 2019. Navigation-guided endoscopic transnasal transsphenoidal approach was used in all the cases. Results: Gross total tumor removal was achieved in 55 (66.26%) patients. We found that gross total resection rate was inversely proportional to Knosp grading, and the extent of resection was found to have a statistically significant correlation with grade of tumor ( P < 0.05). Surgery-related complications were present in 33 of our patients. Nasal complications occurred in six patients: three epistaxis (3.6%) and two hyposmia (2.4%) and one case of septal hematoma (1.2%). Postoperative cerebrospinal fluid leak occurred in six (7.2%) cases, two (2.4%) cases had sinusitis, while two (2.4%) cases had meningitis. There was a very rare case of subarachnoid hemorrhage and one case had sellar hematoma. Endocrinologic complications occurred in 15 (18.07%) patients: anterior pituitary deficiency in five (6.02%) patients, transient diabetes insipidus (DI) in nine (10.84%) patients, and permanent DI in one (1.2%) patient. There was no vascular injury or mortality noted in our study. Conclusion: Endoscopic approach is an effective modality for pituitary surgery; with patience, learning lessons from your own mistakes and by adopting right technique, learning curve can be flattened significantly.

Risk Factors for Significant Postoperative Hemorrhage After Pituitary Neuroendocrine Tumor Resection: A Case-Control Study of 1066 Surgeries

“…This study is limited by its retrospective nature. Although this data set's prevalence of apoplexy and SPH are concordant with the existing literature, [5][6][7][8][20][21][22] the small number of cases makes assessment of long-term outcomes more challenging. Specifically, although there were no mortalities in our cohort, other recent studies have found that up to 42% of SPH cases may be fatal.…”

“…[2][3][4] The rate of SPH after endonasal resection of pituitary neuroendocrine tumor ranges between 0.1% and 1.5, and composes 7.4% of 30-day readmissions for PitNET surgery. [5][6][7][8][9][10][11] Although this is similar to the rate in the broader neurosurgical population, 12 the specific risk factors for developing SPH after pituitary surgery are unknown and potentially unique. This topic has not been investigated thoroughly because of the low incidence of SPH, 13 and as a result, recommendations for prevention and surveillance are lacking.…”

Trans-Sphenoidal Surgery for "Growth Hormone-secreting adenoma; Revisiting Surgical Outcome

“…Of these three elements, only the arachnoid is found in every human (23). In the literature, CSF leaks have been reported varying from 0.5% to 10.3% (20). We had a total of 3 (13,6%) cases with postoperative CSF leak.…”

“…Pituitary adenomas are tumors of extraarachnoidal origin, so usually grow outside the confines of CSF (20). As the tumor lies in close relationship to the diaphragm sellae and subarachnoid space, there is always a risk of iatrogenic arachnoid breach (20).…”

“…Pituitary adenomas are tumors of extraarachnoidal origin, so usually grow outside the confines of CSF (20). As the tumor lies in close relationship to the diaphragm sellae and subarachnoid space, there is always a risk of iatrogenic arachnoid breach (20). As a result, CSF leak is a common complication of this surgery (20) among several transsphenoidal chirurgical complications.…”