Avoiding Complications in Endoscopic Trans-Sphenoidal Surgery for Pituitary Adenoma: A Beginner's Perspective

We aimed to analyze the difficulties and complications experienced while as a beginner in endoscopic transnasal transsphenoidal approach for pituitary adenomas.

We retrospectively analyzed 83 cases done from June 2016 to August 2019. Navigation-guided endoscopic transnasal transsphenoidal approach was used in all the cases.

Gross total tumor removal was achieved in 55 (66.26%) patients. We found that gross total resection rate was inversely proportional to Knosp grading, and the extent of resection was found to have a statistically significant correlation with grade of tumor (P < 0.05). Surgery-related complications were present in 33 of our patients. Nasal complications occurred in six patients: three epistaxis (3.6%) and two hyposmia (2.4%) and one case of septal hematoma (1.2%). Postoperative cerebrospinal fluid leak occurred in six (7.2%) cases, two (2.4%) cases had sinusitis, while two (2.4%) cases had meningitis. There was a very rare case of subarachnoid hemorrhage and one case had sellar hematoma. Endocrinologic complications occurred in 15 (18.07%) patients: anterior pituitary deficiency in five (6.02%) patients, transient diabetes insipidus (DI) in nine (10.84%) patients, and permanent DI in one (1.2%) patient. There was no vascular injury or mortality noted in our study.

Endoscopic approach is an effective modality for pituitary surgery; with patience, learning lessons from your own mistakes and by adopting right technique, learning curve can be flattened significantly.