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01-06-2021 | Meningitis | Original Article

Comparative study of complications after primary and revision transsphenoidal endoscopic surgeries

Authors: Leandro Custódio do Amaral, Baltazar Leão Reis, Antônio Ribeiro-Oliveira Jr, Thamires Marx da Silva Santos, Alexandre Varella Giannetti

Published in: Neurosurgical Review | Issue 3/2021

Abstract

A preferred treatment for residual/recurrent pituitary adenomas has not been established. The existence of higher complication rates for revision surgeries remains under debate. This study aimed to compare complication rates of primary and revision transsphenoidal endoscopic surgeries and to identify risk factors for complications. Data from 144 primary and 39 revision surgeries were analysed. The surgical complications evaluated were intraoperative and postoperative cerebrospinal fluid (CSF) leaks; meningitis; permanent diabetes insipidus (DI) and hypopituitarism; worsening visual acuity; ophthalmoplegias; visual field defects; otorhinolaryngological, systemic and vascular complications; and death. The variables that were potentially associated with surgical complications were gender, age, comorbidities, lumbar drain use, duration of lumbar drain use, invasion of the sphenoid and cavernous sinuses, presence and degree of suprasellar expansion, preoperative identification of the pituitary, CSF leaks and intraoperative pituitary identification. Intraoperative CSF leaks, visual field losses and worsening visual acuity were more common for revision surgeries. There were no between-group differences in the occurrence of postoperative CSF leaks; systemic, vascular and otorhinolaryngological complications; meningitis; DI and hypopituitarism; ophthalmoplegias; or death. Intraoperative identification of the pituitary was associated with lower rates of permanent DI and hypopituitarism, systemic complications, intraoperative CSF leaks and worsening visual acuity. Suprasellar expansion increased the risk of intraoperative CSF leaks but not endocrinological deficits or visual impairment. Intraoperative CSF leaks were associated with postoperative CSF leaks, meningitis, anterior hypopituitarism, DI and worsening visual acuity. Intraoperative CSF leaks, worsening visual acuity and visual field losses were more common in reoperated patients.

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Title: Comparative study of complications after primary and revision transsphenoidal endoscopic surgeries
Authors: Leandro Custódio do Amaral
Baltazar Leão Reis
Antônio Ribeiro-Oliveira Jr
Thamires Marx da Silva Santos
Alexandre Varella Giannetti
Publication date: 01-06-2021
Publisher: Springer Berlin Heidelberg
Keywords: Meningitis
Hypopituitarism
Published in: Neurosurgical Review / Issue 3/2021
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-020-01360-w

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Comparative study of complications after primary and revision transsphenoidal endoscopic surgeries

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