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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(04): 899-907
DOI: 10.4103/ajns.AJNS_121_20
Original Article

Avoiding complications in endoscopic trans-sphenoidal surgery for pituitary adenoma: A beginner's perspective

Pawan Goyal
Department of Neurosurgery, Artemis Hospital, Gurgaon, Haryana
,
Aditya Gupta
Department of Neurosurgery, Artemis Hospital, Gurgaon, Haryana
,
Sanjeev Srivastava
Department of Neurosurgery, Artemis Hospital, Gurgaon, Haryana
,
Shilpi Modi
1   Department of Pathology, Artemis Hospital, Gurgaon, Haryana
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Introduction: We aimed to analyze the difficulties and complications experienced while as a beginner in endoscopic transnasal transsphenoidal approach for pituitary adenomas. Materials and Methods: We retrospectively analyzed 83 cases done from June 2016 to August 2019. Navigation-guided endoscopic transnasal transsphenoidal approach was used in all the cases. Results: 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. Conclusion: 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.

Key-words:

Adenoma - complications - endoscopic - pituitary

Financial support and sponsorship

Nil.




Publication History

Received: 28 March 2020

Accepted: 26 June 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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