title: Complications Related to the Endoscopic Endonasal Transsphenoidal Approach for Nonfunctioning Pituitary Macroadenomas in 300 Consecutive Patients.
abstract: OBJECTIVE
  To analyze complications of endoscopic transsphenoidal surgery (ETS) for nonfunctioning pituitary macroadenomas (NFPAs).
  
  
  METHODS
  A retrospective study of 300 NFPAs was performed. Complications and factors that could influence these complications were analyzed.
  
  
  RESULTS
  Visual and pituitary functions worsened in 2.4% and 13.7% of cases, respectively. Postoperative diabetes insipidus was permanent in 6.2% of cases. Postoperative meningitis occurred in 3.3% of patients. Meningitis was strongly associated with intraoperative cerebrospinal fluid (CSF) leaks (P = 0.01), postoperative CSF leaks (P = 0.0001), and operation times longer than 1 hour (P = 0.023). Detection of Staphylococcus aureus and preoperative treatment with mupirocin in the nostrils did not impact the occurrence of meningitis. Two patients with meningitis died (unique causes of death). Postoperative CSF leaks occurred in 2.7% of cases and were associated with intraoperative CSF leaks (P = 0.007) and permanent diabetes insipidus (P = 0.028). The rate of CSF leak decreased from 4% to 0.8% (P = 0.048) after we moved from a soft to hard reconstruction of the sella. The rate of postoperative epistaxis decreased from 6.7% to 1.25% after we stopped using monopolar coagulation (P = 0.013).
  
  
  CONCLUSIONS
  ETS permits a wide view, allowing good conditions for a satisfactory resection in the majority of NFPAs. Some pitfalls of endoscopy can lead to complications that improve with modification of the operative technique (i.e., CSF leak and postoperative epistaxis). This study confirms an acceptable rate of complications associated with ETS.
authors.affiliation: Department of Neurosurgery, CHU de la Timone, Université de la méditérannée, Marseille, France.
authors.forename: Elsa
authors.initials: E
authors.lastname: Magro
authors.affiliation: Department of Neurosurgery, CHU de la Timone, Université de la méditérannée, Marseille, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Graillon
authors.affiliation: Department of Neurosurgery, CHU de la Timone, Université de la méditérannée, Marseille, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Lassave
authors.affiliation: Department of Endocrinology, CHU de la Conception, Université de la méditérannée, Marseille, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Castinetti
authors.affiliation: Department of Neurosurgery, CHU de la Timone, Université de la méditérannée, Marseille, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Boissonneau
authors.affiliation: Department of Neuro-oncology, CHU de la Timone, Université de la méditérannée, Marseille, France.
authors.forename: Emline
authors.initials: E
authors.lastname: Tabouret
authors.affiliation: Department of Neurosurgery, CHU de la Timone, Université de la méditérannée, Marseille, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Fuentes
authors.affiliation: Intensive Care Unit, CHU de la Timone, Université de la méditérannée, Marseille, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Velly
authors.affiliation: Department of Neurosurgery, CHU de la Timone, Université de la méditérannée, Marseille, France.
authors.forename: Regis
authors.initials: R
authors.lastname: Gras
authors.affiliation: Department of Neurosurgery, CHU de la Timone, Université de la méditérannée, Marseille, France. Electronic address: hdufour@ap-hm.fr.
authors.forename: Henry
authors.initials: H
authors.lastname: Dufour
mesh_terms: D000236:Adenoma / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000382:microbiology / Q000601:surgery; D044583:Neuroendoscopy / Q000009:adverse effects* / Q000379:methods*; D010911:Pituitary Neoplasms / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D013211:Staphylococcus aureus; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complication; Endoscopy; Learning curve; Nonfunctioning pituitary macroadenoma; Pituitary adenoma; Transsphenoidal