Complication Rates after Endoscopic Transsphenoidal Surgery for ACTH-Secreting Pituitary Adenomas: A Comparative Analysis with GH and Nonfunctioning Adenomas

Juan Á. Aibar-Durán; Michael Oladotun-Anka; Carlos Asencio-Cortés; Elena Valassi; Susan Webb; Juan R. Gras-Cabrerizo; Joan Monserrat-Gili; Pere Tresserras Ribó; Fernando Muñoz-Hernández

doi:10.1055/s-0041-1725029

Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

J Neurol Surg B Skull Base 2022; 83(S 02): e274-e283
DOI: 10.1055/s-0041-1725029

Original Article

Complication Rates after Endoscopic Transsphenoidal Surgery for ACTH-Secreting Pituitary Adenomas: A Comparative Analysis with GH and Nonfunctioning Adenomas

Juan Á. Aibar-Durán

¹Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain

,

Michael Oladotun-Anka

¹Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain

,

Carlos Asencio-Cortés

¹Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain

,

Elena Valassi

²Department of Endocrinology, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain

³Sant Pau Research Institut, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain

,

Susan Webb

²Department of Endocrinology, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain

³Sant Pau Research Institut, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain

,

Juan R. Gras-Cabrerizo

⁴Department of ENT Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain

,

Joan Monserrat-Gili

⁴Department of ENT Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain

,

Pere Tresserras Ribó

¹Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain

,

Fernando Muñoz-Hernández

¹Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain

› Institutsangaben

Abstract

Objectives Some complications have been more frequently reported after surgery for adrenocorticotropin hormone (ACTH)-secreting pituitary adenomas. We compared complication rates in patients with ACTH-secreting pituitary adenomas with those in patients with growth hormone secreting pituitary adenomas (growth hormone [GH] group) and nonfunctioning adenomas (nonfunctioning group).

Design A comparative three-group analysis was performed for all patients who had endoscopic transsphenoidal surgery for pituitary adenomas at our center between January 2011 and May 2019. Variables included demographics, preoperative clinical and radiological characteristics, and postoperative radiological and endocrinological outcomes. Complications were divided into four categories: endocrinological, neurosurgical, medical, and ENT (ear–nose–throat)-related complications. Univariate and multivariate statistical analysis were performed.

Results A total of 111 patients with pituitary adenomas and a mean age of 53.7 years were included (25 ACTH, 35 GH, and 51 nonfunctioning adenomas). Overall, 28 patients had microadenomas (25.2%) and 83 had macroadenomas (74.8%). Univariate statistical analysis for complications between groups showed no differences in neurosurgical and medical complications. Transient diabetes insipidus and postsurgical bacterial sinusitis were the only variables more frequently seen in the ACTH group (p = 0.01 and 0.04, respectively). Multivariate analysis for transient diabetes insipidus showed no differences between groups (p = 0.58).

Conclusion Complication rates were similar in all three adenoma groups, particularly concerning major infections, thrombotic events, postoperative cerebrospinal fluid (CSF) leak, and transient diabetes insipidus. Transient diabetes insipidus was related with adenoma size and intraoperative CSF leak. Despite postoperative bacterial sinusitis was statistically higher in the ACTH group, this data should be interpreted with caution given the low number of patients with this complication.

Keywords

pituitary adenoma - complications - endoscopic transsphenoidal surgery - ACTH-secreting adenomas

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