Surgical complications after transsphenoidal microscopic and endoscopic surgery for pituitary adenoma: a consecutive series of 506 procedures

Abstract

Background: The aim of this study was to establish the rates of postoperative complications after transsphenoidal microscopic and endoscopic surgery.

Method: All transsphenoidal procedures for histologically verified pituitary adenomas performed between September 2002 and February 2011 were included in this retrospective study. The data were retrieved from a prospectively collected database of all tumor surgeries performed and from medical record review. No patients were lost to follow-up, with a median follow-up time of 28 months (range 3 – 103 months).

Results: There were 506 transsphenoidal procedures performed on 446 patients in the defined period. Median age at time of surgery was 57 years (range 9 – 85 years), and 58% were males. There were 268 microscopic and 238 endoscopic procedures. There were 352 non-functioning adenomas and 154 hormone secreting. A total of 73% of the procedures were primary surgeries and 27% were repeat surgery for tumor recurrence. The overall complication rate was 9.1%. The three most frequent complications were CSF leakage (4.7%), meningitis (2%) and visual deterioration (2%). Multivariate analyses showed an increased overall risk for complications with increasing age, surgery for recurrent tumor and surgery performed by low volume surgeons. There was no significant difference in the overall complication rate between microsurgical and endoscopic technique. The surgical mortality was 0.6%, and overall survival at 1 and 5 years was 95% and 90%, respectively.

Conclusions: We did not find any significant difference between the two techniques, though one must keep in mind that the introductory period of the endoscopic technique is included in the study. Surgical mortality was low. Overall survival at 1 and 5 years was, however, significantly lower for patients undergoing transsphenoidal surgery compared to the control population, most likely due to the pituitary disease per se.