PURPOSE Transcranial surgery(TCS) for pituitary adenoma(PA) is mostly reserved for lesions with widespread extensions. We sought to analyse the intraoperative challenges, morbidity and the factors associated with morbidity of transcranial approaches, in a large series from a tertiary neurosurgical institute. METHODS We retrospectively evaluated 137 patients who underwent TCS for PA in our institute. The details of their clinical features, imaging, operative and peri-operative events and complications were collected and analysed. The factors associated with morbidity were evaluated. RESULTS The mean age of the cohort was 40.86 ± 13.35 years. 21 (15.3%) patients developed significant post-operative hematoma, out of which 7 patients (5.1%) required re-exploration. Post-operative diabetes insipidus was noted in 45 patients (32.84%), while SIADH was noted in 10 patients (7.35%). Other complications were cranial nerve palsy in 14 patients (10.2%), visual deterioration in 7 patients (5.1%). Neither tumour characteristics nor the choice of approach was associated with occurrence of post op hematoma. SIADH was significantly associated with patients with tumours involving cavernous sinus (p = 0.019) and subfrontal extension (p = 0.031). Patients with post-operative hematoma had significantly higher incidence of post-op DI (57.1% vs 28.7%; p = 0.021), while similar correlation was not noticed with SIADH (4.7 vs 7.8%). CONCLUSION TCS plays a distinct, albeit a small role in surgical management of pituitary adenoma. Tumour related or approach related factors are not significantly associated with the incidence of hematoma. Post-operative hematoma significantly influences the incidence of DI. A proper and judicious selection of approach and meticulous surgical technique should result in a reduction in associated morbidity and mortality.

中文翻译：

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垂体腺瘤的经颅入路——对过去二十年的手术入路和影响围手术期发病率的因素的评估

目的 垂体腺瘤 (PA) 的经颅手术 (TCS) 主要用于广泛扩展的病变。我们试图在来自三级神经外科研究所的大型系列中分析术中挑战、发病率和与经颅入路发病率相关的因素。方法 我们回顾性评估了我们研究所接受 TCS 治疗 PA 的 137 名患者。收集并分析了他们的临床特征、影像学、手术和围手术期事件和并发症的详细信息。评估了与发病率相关的因素。结果 队列的平均年龄为 40.86 ± 13.35 岁。21 (15.3%) 名患者出现明显的术后血肿，其中 7 名 (5.1%) 患者需要重新探查。45 名患者（32.84%）出现术后尿崩症，而 SIADH 在 10 名患者中被发现（7.35%）。其他并发症包括颅神经麻痹 14 例（10.2%），视力下降 7 例（5.1%）。肿瘤特征和入路选择均与术后血肿的发生无关。SIADH 与涉及海绵窦（p = 0.019）和额下扩展（p = 0.031）的肿瘤患者显着相关。术后血肿患者术后 DI 的发生率显着升高（57.1% 对 28.7%；p = 0.021），而与 SIADH 没有发现类似的相关性（4.7% 对 7.8%）。结论 TCS 在垂体腺瘤的手术治疗中发挥着独特的作用，尽管作用很小。肿瘤相关或入路相关因素与血肿发生率无显着相关性。术后血肿显着影响 DI 的发生率。适当和明智地选择入路和细致的手术技术应该会降低相关的发病率和死亡率。