Comparative study of complications after primary and revision transsphenoidal endoscopic surgeries.

Szczegóły
Abstrakt

Tytuł:: Comparative study of complications after primary and revision transsphenoidal endoscopic surgeries.
Autorzy:: do Amaral LC; Belo Horizonte, Brazil. leandroamaral_.
Reis BL; Nova Lima, Brazil.
Ribeiro-Oliveira A Jr; Belo Horizonte, Brazil.
da Silva Santos TM; Belo Horizonte, Brazil.
Giannetti AV; Belo Horizonte, Brazil.
Źródło:: Neurosurgical review [Neurosurg Rev] 2021 Jun; Vol. 44 (3), pp. 1687-1702. Date of Electronic Publication: 2020 Aug 11.
Typ publikacji:: Comparative Study; Journal Article
Język:: English
Imprint Name(s):: Publication: Berlin : Springer Berlin Heidelberg
Original Publication: Berlin : Walter De Gruyter
MeSH Terms:: Adenoma/*surgery
Neurosurgical Procedures/*adverse effects
Pituitary Neoplasms/*surgery
Postoperative Complications/*etiology
Reoperation/*adverse effects
Sphenoid Bone/*surgery
Adenoma/diagnostic imaging ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cerebrospinal Fluid Leak/diagnostic imaging ; Cerebrospinal Fluid Leak/etiology ; Child ; Drainage/adverse effects ; Drainage/trends ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures/trends ; Pituitary Neoplasms/diagnostic imaging ; Postoperative Complications/diagnostic imaging ; Reoperation/trends ; Retrospective Studies ; Risk Factors ; Sphenoid Bone/diagnostic imaging ; Young Adult
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Contributed Indexing:: Keywords: Endoscopy; Hypophysectomy; Pituitary gland; Pituitary neoplasms; Postoperative complications; Reoperation
Entry Date(s):: Date Created: 20200813 Date Completed: 20210629 Latest Revision: 20210629
Update Code:: 20240105
DOI:: 10.1007/s10143-020-01360-w
PMID:: 32783077
: Czasopismo naukowe

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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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