Immediate postoperative complications of sellar suprasellar lesions operated via pterional approach

Muhammad Ayaz,Samina Feroz,Naseer Hassan,Zulfiqar Ali Shah,Farooq Azam,Hamayun Tahir,Mumtaz Ali

doi:10.36552/pjns.v25i4.514

Abstract

Objective: In neurosurgical facilities, lesions that occur in the sella turcica and suprasellar area are frequently encountered. Different complications have been documented in the past studies following surgical management of sellar suprasellar lesions. This study's rationale was to get data from our local population on complications related to the transcranial approach for sellar suprasellar lesions. The study aimed to determine the immediate (within one week) postoperative complications of sellar suprasellar lesions operated via a pterional approach Material and Methods: This descriptive case series study was conducted from June 2019 to June 2020 at the neurosurgical facility lady reading hospital Peshawar. A total of 117 patients, meeting inclusion criteria irrespective of gender, diagnosed with the sellar suprasellar lesion between 18 to 60 years of age operated through a pterional approach. Post-op patients were followed for seven days to access main outcome measures such as CSF leak and diabetes insipidus. Results: CSF leak found in 7.7% (n = 9) of patients while diabetes insipidus was detected in 14.5% (n = 17) patients. Gender and age-based stratification showed no statistically significant difference for both postoperative complications. Conclusion: Diabetes insipidus was a more frequent postoperative complication in patients undergoing the pterional approach for sellar suprasellar lesions followed by CSF leak. However, no statistically significant correlation was observed between different age groups and gender for all these complications.

Highlights

The sellar suprasellar area lesions are deeply rooted and far closer to the anterior skull base's essential structures
CSF leak found in 7.7% (n = 9) of patients while diabetes insipidus was detected in 14.5% (n = 17) patients
Diabetes insipidus was a more frequent postoperative complication in patients undergoing the pterional approach for sellar suprasellar lesions followed by CSF leak

Summary

Introduction

The sellar suprasellar area lesions are deeply rooted and far closer to the anterior skull base's essential structures. Recent advances in exposure to cranial base, microsurgical procedures, neuroimaging, and neuronavigation have resulted in a greater extent of tumor resection and better surgical outcomes.[7,8] The frontotemporal approach, known as the pterional approach, is best known to many neurosurgeons because of its advantage of direct visual confirmation and easy accessibility to optic nerves, carotid arteries, pituitary gland, and stalk, tumor, and its relationship with sellar suprasellar structures. This technique provides several windows to the sellar suprasellar region once Sylvian fissure is being opened, such as prechiasmatic, trans-lamina terminal is, suprachiasmatic, between the optic nerve and internal carotid artery, lateral to and above internal carotid artery and its bifurcation, making it the most commonly used technique in neurosurgery nowadays.[9,10]

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Conclusion