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Comparative study of complications after primary and revision transsphenoidal endoscopic surgeries

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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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Data availability

The datasets generated and/or analysed during the current study, including patient-level data, are available from the corresponding author upon request and in the library of the Faculty of Medicine of the Federal University of Minas Gerais.

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Authors and Affiliations

  1. Belo Horizonte, Brazil

    Leandro Custódio do Amaral, Antônio Ribeiro-Oliveira Jr, Thamires Marx da Silva Santos & Alexandre Varella Giannetti

  2. Nova Lima, Brazil

    Baltazar Leão Reis

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  1. Leandro Custódio do Amaral
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  2. Baltazar Leão Reis
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  5. Alexandre Varella Giannetti
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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Research Ethics Committee (Comitê de Ética em Pesquisa, COEP) of the Federal University of Minas Gerais, CAAE project - 54787216.7.0000.5149, on 6 July 2016.

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Although informed consent is not required in this type of study, it was obtained from all patients.

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do Amaral, L.C., Reis, B.L., Ribeiro-Oliveira, A. et al. Comparative study of complications after primary and revision transsphenoidal endoscopic surgeries. Neurosurg Rev 44, 1687–1702 (2021). https://doi.org/10.1007/s10143-020-01360-w

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  • DOI: https://doi.org/10.1007/s10143-020-01360-w

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