Complications after trans-sphenoidal surgery: our experience and a review of the literature

Abstract

The incidence of surgical complications after trans-sphenoidal surgery for pituitary lesions is low. The influence of size of thelesion and its pathology on the incidence of different types of complications and the remission rate of functioning adenomasare addressed in this retrospective study. Between 1996 and 2001, 126 trans-sphenoidal operations were performed on 108patients with pituitary pathologies. Diabetes insipidus (DI) was the commonest (23%) and the incidence was higher withmicroadenomas and in those with Cushing's disease (p < 0.05). Other important complications were: postoperativehypopituitarism 22%, CSF leak 13%, meningitis 5.5%, pneumocephalus 2.4%, visual deterioration 1.5%, haematoma 0.8%and 30-day mortality rate of 0.8%. Other complications encountered were subdural haematoma, epistaxis, SIADH, sphenoidabscess, deep vein thrombosis, thalamic infarct and hydrocephalus. No vascular injuries were encountered. The overallremission rate for acromegaly and Cushing's disease (22 patients each) was 77 and 81%, respectively. The remission rate was100% for microadenomas, 89% for both acromegaly and Cushing's disease. More aggressiveness towards complete tumourremoval increases the biochemical cure rate of functioning adenomas and on the other hand results in higher incidence of CSFleak and hypopituitarism.