Complications in Endoscopic Endonasal Pituitary Adenoma Surgery: An Institution Experience in 310 Patients

Abstract

Objective: Endoscopic Endonasal approaches (EEA) have shown excellent results for majority of hypophyseal tumors. The aim of this study was to evaluate and report the complications of EEA in patients with Pituitay Adenoma (PA) who underwent surgery between 2013 and 2018. Methods: We performed a retrospective review of 310 consecutive patients/325 procedures with PA treated with an Endoscopic Endonasal (EEA) approach from May 2013 to January 2018. Minor complications including transient diabetes insipidus (DI) or new anterior pituitary hormone insufficiency in one axis and major complications including CSF leakage, hematoma needing reoperation, vascular damage, brain infection, new pan-hypopituitarism permanent DI, new visual impairment, neurological deficits, and mortality were recorded. Results: We encountered 58 complications in 310 patients (18.7%) and in 325 procedures (17.7%). Minor complications were 43 (13.9% and 13.2%) in 310 patients and in 325 procedures respectively; whereas, major complications were 28 (9% and 8.6% respectively). Total complications were associated with diameter group 2 (>30 mm), diaphragm sella violation, suprasellar extension, paraselar involvement, nonfunctional secretory type, intraoperative arachnoid tearing Conclusion: EEA can be considered as a safe surgical treatment with acceptable complications in the management of pituitary adenomas.

Vascular Complications of Endoscopic Transsphenoidal Approach to Sellar Base Lesions

“…2,3 Transsphenoidal approach to sellar base leasions is known to be associated with low complication rates. 4,5 Vascular complications, especially internal carotid artery (ICA) injuries, are one of the dangerous complications of endoscopic skull base surgeries. 6 Injury to the ICA accounts for approximately 1% of complications during transsphenoidal surgery.…”

Internal carotid artery injury during endoscopic endonasal surgery for skull base pathologies: an institutional incidence, management, and outcome

“…Endoscopic endonasal surgery (EES) has become the popular approach to deal with ventral skull base pathologies. Endoscopic techniques are currently used to treat various benign and malignant pathologies and the most common include pituitary adenomas, craniopharyngiomas, chordomas, Rathke's cyst, and skull base defects with excellent results 1–6 …”

“…Endoscopic techniques are currently used to treat various benign and malignant pathologies and the most common include pituitary adenomas, craniopharyngiomas, chordomas, Rathke's cyst, and skull base defects with excellent results. [1][2][3][4][5][6] Similar to every neurosurgical procedure, EES is associated with complications. The most catastrophic intra-operative complication in EES is internal carotid artery (ICA) injury.…”