Operative Strategies to Minimize Complications Following Resection of Pituitary Macroadenomas.
IntroductionWe sought to identify factors associated with increased length of stay (LOS) and morbidity in patients undergoing resection of pituitary macroadenomas.MethodsWe reviewed records of 203 consecutive patients who underwent endoscopic endonasal resection of a pituitary macroadenoma (mean age = 55.7 [16-88]) years, volume = 11.3 (1.0-134.3) cm3. Complete resection was possible in 60/29.6% patients. Mean follow-up was 575 days. Multivariate logistic regression was performed using MATLAB.ResultsMean LOS was 4.67 (1-66) days and was associated with CSF leak (p= 0.025), lumbar drain placement (p= 0.041;n= 8/3.9% intraoperative,n= 20/9.9% postoperative), and any infection (p= 0.066). Age, diabetes insipidus (n= 17/8.37%), and syndrome of inappropriate antidiuretic hormone secretion (n= 12/5.9%) were not associated with increased LOS (p> 0.2). Postoperative CSF leak in the hospital (n= 21/10.3%) was associated with intraoperative CSF leak (p= 0.002;n= 82/40.4%) and complete resection (p= 0.012). There was no significant association (p> 0.1) between postoperative CSF leak in the hospital following surgery and the use of a fat graft (n= 61/30.1%), nasoseptal flap (155/76.4%), or perioperative lumbar drain placement (n= 8/3.94%).ConclusionComplete resection is associated with increased risk of CSF leak and LOS. Operative strategies including placement of fat graft, nasoseptal flap, or intraoperative lumbar drain placement may have limited value in reducing the risk of postoperative CSF leak.
Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States; School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Jayesh P
JP
Thawani
Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Ashwin G
AG
Ramayya
Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Jared M
JM
Pisapia
Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Kalil G
KG
Abdullah
Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
John Y-K
JY
Lee
Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
M Sean
MS
Grady
length of stay; pituitary macroadenoma