Complications of direct endonasal transsphenoidal approach for treating pituitary adenomas

Abstract

Objective To assess surgical complications of direct endonasal transsphenoidal approach for treating pituitary adenomas. Methods Retrospective analysis was performed to assess surgical complications in a series of 220 patients with pituitary adenomas from October 2005 to June 2008. Complications were analysed according to the anatomical structures of the approach and the functional systems of pituitary gland. Results One hundred and twenty⁃nine females and 91 males (median age 44 years old) underwent direct endonasal transsphenoidal approach for pituitary adenomas removal. Of the pituitary adenomas, 143 were non ⁃ functioning and 77 were hormonally active. There were 41 microadenomas, 147 macroadenomas and 32 giant adenomas. All complications were recorded at 3, 6, 12 and 24 months after the procedure. The complications were divided into 5 groups. Nasal complications were seen in 34 patients (15.45% ), postoperative sphenoiditis in 4 cases (1.82% ), cerebrospinal fluid rhinorrhea in 25 cases (11.36%), suprasellar and parasellar complications in 8 cases (3.64%), and those associated with endocrine disorders of pituitary gland in 27 cases (12.27% ). Four patients died of postoperative suprasellar hemorrhage and the mortality was 1.82%. All these fatal complications occurred in the first 100 cases of the direct endonasal transsphenoidal approach. Conclusion The direct endonasal transsphenoidal approach provides a safe and effective route for removal of pituitary adenomas. The reduction of complications is not only determined by technique itself, but also by a cautious surgical strategy. DOI：10.3969/j.issn.1672-6731.2010.05.009