COMPLICATIONS OF THE ENDOSCOPIC TRANSSPHENOIDAL SURGERY FOR PITUTIARY ADENOMA
Main Article Content
Keywords
Pituitary adenomas, endoscopic transsphenoidal surgery, complications, cerebrospinal fluid leaks, BMI, perioperative outcomes, 30-day mortality
Abstract
Objective: To evaluate complications associated with endoscopic transsphenoidal surgery for pituitary adenomas, focusing on patient demographics, BMI, and perioperative outcomes.
Method: This prospective observational study was conducted at the Department of Neurosurgery, Mardan Medical Complex, and Lady Reading Hospital, from October 2022 to September 2023. A total of 100 patients undergoing endoscopic transsphenoidal surgery were analyzed for demographic and clinical characteristics, including age, BMI, and comorbidities. Postoperative outcomes, such as CSF leaks, infections, neurological complications, and 30-day mortality, were assessed. Statistical analysis was conducted to identify risk factors and correlations.
Result: The mean age of patients was 65 years, with a mean BMI of 28.5 kg/m². Higher BMI (>31.4 kg/m²) and older age (>40 years) were associated with increased complication rates, including CSF leaks (7.5% vs. 3.3%, p = 0.23) and infections (5% vs. 1.7%, p = 0.15). The overall surgical success rate was 90%, but older patients exhibited a higher 30-day mortality rate (7.5%, p = 0.05) compared to younger patients. Complication rates were relatively low, underscoring the benefits of standardized surgical protocols.
Conclusion: Endoscopic transsphenoidal surgery for pituitary adenomas is associated with high success rates and low complication rates. However, older age and higher BMI are significant risk factors for postoperative complications. These findings emphasize the need for tailored perioperative management and lifestyle modifications to optimize outcomes and reduce risks.
References
2. K. Goshtasbi, B.M. Lehrich, M. Abouzari, et al. Endoscopic versus nonendoscopic surgery for resection of pituitary adenomas: a national database study. J Neurosurg, 134 (2021), pp. 816-824
3. D.J. Lobatto, F. de Vries, N.A.H. Zamanipoor, et al. Preoperative risk factors for postoperative complications in endoscopic pituitary surgery: a systematic review Pituitary, 21 (2018), pp. 84-97
4. S. Deb, D.B. Vyas, A.V. Pendharkar, et al. Socioeconomic predictors of pituitary surgery Cureus, 11 (2019), Article e3957
5. HCUP overview of the national (nationwide) inpatient sample (NIS) Available at: https://hcup-us.ahrq.gov/nisoverview.jsp%0A, Accessed 12th Oct 2023
6. R. Aggarwal, N. Chiu, R.K. Wadhera, et al. Racial/ethnic disparities in hypertension prevalence, awareness, treatment, and control in the United States, 2013 to 2018. Hypertens (Dallas, Tex 1979), 78 (2021), pp. 1719-1726
7. A.O. Asemota, G.L. Gallia. Impact of frailty on short-term outcomes in patients undergoing transsphenoidal pituitary surgery. J Neurosurg, 132 (2019), pp. 360-370
8. B.A. Strickland, J. Lucas, B. Harris, et al. Identification and repair of intraoperative cerebrospinal fluid leaks in endonasal transsphenoidal pituitary surgery: surgical experience in a series of 1002 patients. J Neurosurg JNS, 129 (2018), pp. 425-429
9. E.M.H. Slot, R. Sabaoglu, E.H.J. Voormolen, E.W. Hoving, T.P.C. van Doormaal Cerebrospinal fluid leak after transsphenoidal surgery: a systematic review and meta-analysis
10. J Neurol Surg B Skull Base, 83 (Suppl 2) (2022), pp. e501-e513
11. M. Makwana, P.N. Taylor, B.T. Stew, et al. Smoking and obesity are risk factors for thirty-day readmissions following skull base surgery. J Neurol Surg B Skull Base, 81 (2020), pp. 206-212
12. Y.-J. Lee, A. Wong, A. Filimonov, et al. Impact of body mass index on perioperative outcomes of endoscopic pituitary surgery. Am J Rhinol Allergy, 32 (2018), pp. 404-411
13. J.D. Thakur, A. Corlin, R.J. Mallari, et al. Complication avoidance protocols in endoscopic pituitary adenoma surgery: a retrospective cohort study in 514 patients. Pituitary, 24 (2021), pp. 930-942
14. Tritos, N.A.; Miller, K.K. Diagnosis and Management of Pituitary Adenomas. JAMA 2023, 329, 1386–1398
15. Esposito, D.; Olsson, D.S.; Ragnarsson, O.; Buchfelder, M.; Skoglund, T.; Johannsson, G. Non-Functioning Pituitary Adenomas: Indications for Pituitary Surgery and Post-Surgical Management. Pituitary 2019, 22, 422–434
16. Chen, J.; Liu, H.; Man, S.; Liu, G.; Li, Q.; Zuo, Q.; Huo, L.; Li, W.; Deng, W. Endoscopic vs. Microscopic Transsphenoidal Surgery for the Treatment of Pituitary Adenoma: A Meta-Analysis. Front. Surg. 2022, 8, 806855.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Asghar Ali
Assistant Professor of Neurosurgery, Mardan Medical Complex BKMC, Mardan, Pakistan
Sohail Ahmad
Assistant Professor of Neurosurgery, Wah Medical College, POF Hospital, Wah Cantt, Pakistan
Mewat Shah
Assistant Professor of Neurosurgery, Gajju Khan Medical College, Swabi, Pakistan
Muhammad Mehboob Alam
FCPS, Assistant Professor of Neurosurgery, Wah Medical College, Wah Cantt, Pakistan
Mazhar Hamdani
Assistant Professor of Neurology, AJK Medical College, Muzaffarabad, AJK
Jahanzeb Kakar
Assistant Professor of Neurosurgery, Loralai Medical College, Loralai, Pakistan