Outcomes and complications of 111 patients with pituitary neoplasms after neuroendoscopic endonasal transsphenoidal surgeries

Abstract

Objective To explore the outcomes and complications of 111 patients with pituitary neoplasms after neuroendoscopic endonasal transsphenoidal surgeries. Methods A retrospective review of clinical and radiographic data of 111 patients (113 procedures), admitted to our hospital from June 2010 to July 2014, was performed. The resection rate, clinical cured rate and complications in pituitary neoplasms of different Knosp classifications were compared. Results Gross total resection(GTR) rate for pituitary neoplasms according to Knosp classification was 97.4% in grade 0, 85.7% in grade 1, 88.7% in grade 2, 51.9% in grade 3 and 0% in grade 4, with significant differences (P 0.05). Chief complaints were improved in 75.0%-91.7% non-functioning adenomas. Postoperative severe complications included 3 patients (2.7%) with cerebrospinal fluid rhinorrhea, 4 (3.5%) intracranial hematoma, 1 (0.9%); postoperative mild complications included 3 (2.7%) epistaxis, 14(12.4%) transient diabete insipidus, 1 (0.9%) permanent diabetes insipidus and 3 (2.7%) hyponatremia. Mortality was observed in one patient with intracranial hematoma. Conclusions Neurendoscope provides a superior view of the sellar region, and improves the extent of resection of pituitary adenoma especially for those with cavernous sinus invasion; however, blind pursuit of GTR for tumor with Knosp classification greater than grade 3 will increase the risk of severe complications. Safety should always be the priority for a procedure with a long learning curve like neuroendoscopic surgery. Remission of residue tumor can be addressed by subsequent radiotherapy/stereotactic surgery. Key words: Neuroendoscope; Pituitary neoplasm; Treatment outcome; Postoperative complication