Single-surgeon endoscopic endonasal transsphenoidal surgery for pituitary adenomas: surgical outcomes and complications of 197 cases

Abstract

Background : The purpose of this study was to report the outcomes and complications of single-surgeon endoscopic endonasal transsphenoidal surgery for pituitary adenomas and compare the findings with those in published studies. Materials and Methods : We reviewed the data for 197 endoscopic procedures performed for pituitary adenomas between January 2001 and December 2016. Demographic, endocrinological, and radiological data as well as the surgical outcomes and complications were retrospectively analyzed. Results : There were 98 nonfunctioning adenomas and 99 hormone-secreting adenomas. The rate of gross total resection was 64.0%. Hormonal remission was achieved for 71.7% hormone-secreting adenomas after a median follow-up of 40 months. The overall complication rate was 33.5% (21.3% of minor and 13.2% of major complications) after 197 surgeries. The most common complication was transient diabetes insipidus (DI, 12.2%). There were 26 cases of major complications; two permanent DI, nine anterior pituitary dysfunctions, six postoperative cerebrospinal fluid leak with revision surgery. There were postoperative hemorrhage in three patients, three meningitis in three (1.5%); 50% of these patients died of these complications. Conclusions : Our findings suggest that, compared with conventional microscopic surgery, endoscopic endonasal pituitary surgery can be less invasive and provide better visualization. Although microscopic surgery performed by experienced surgeons can achieve satisfactory results, we believe that endoscopic pituitary surgery will be more widely used because of the favorable outcomes and minimal invasiveness.