Management of Complications in Endoscopic Endonasal Surgery for Pituitary Adenomas

Juan Luis Gómez Amador

doi:10.4172/2329-6895.1000209

Abstract

Objective: To describe a case series of patients with pituitary adenomas with endoscopic endonasal transsphenoidal approach, the technique performed and complications in our centre. Methods: The technique performed in a series of 98 consecutive patients, and description of their complications and the protocol followed to treat these complications. Results: 120 patients where submitted to Skull Base Endoscopic Surgery, of which 98 (81.66%) had diagnosis of non-functioning pituitary adenoma in a two year period. Complications described are postoperative cerebrospinal fluid leaks (6.12%), vascular injury (3.06%) and cranial nerve injury (2.04%). Conclusion: A specific protocol is followed in our institution to treat different complications in pituitary adenoma transnasal endoscopic surgery in order to improve outcomes. Prompt and diligent identification of complications is of utmost importance for their treatment.

Highlights

Invasive procedures in neurosurgery, during the last 2 decades have become a constant subject of update and evolution [1]
We describe a case series of patients operated in the Neurosurgery Department of our institution with diagnosis of Non-functioning Pituitary Adenoma, through Transnasal Endoscopic Surgery in the period between 2013 and 2014 in conjunction with the Otolaryngology department
Surgical complications were classified in the following manner: 1) Vascular Complications, with intraoperative haemorrhage by vascular injury; 2) Postoperative CSF leak, when the patient presented with liquid spill in the postoperative follow-up by the otolaryngology team, when endoscopic endonasal exam was performed; 3) Cranial Nerve injury, when the patient presented with visual impairment compared to their preoperative status, or presented with ophthalmoplegia; 4) Panhypopituitarism, when the patient required hormonal replacement in more than 2 hormonal axis, when there was no preoperative hormonal deficit

Summary

Introduction

Invasive procedures in neurosurgery, during the last 2 decades have become a constant subject of update and evolution [1]. The origin of this approach to the sella turcica has been attributed to the work of researchers like Carrau, Jho, Cappabianca, Frank among others [2,3,4]

Methods

Results

Discussion

Conclusion