159 Factors Associated with Postoperative Complications Following Transsphenoidal Surgery for Pituitary Tumor resection from the national Surgical Quality Improvement Program (NSQIP)

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 239-240
Author(s):  
Andrew Karl Rock ◽  
Charles Frederick Opalak ◽  
Kathryn Workman ◽  
Matthew Carr ◽  
William C Broaddus
Keyword(s):  
Postoperative Complications ◽  
Transsphenoidal Surgery ◽  
Tumor Resection ◽  
Pituitary Tumors ◽  
Pituitary Surgery ◽  
Improvement Program ◽  
Surgical Quality ◽  
Duration Of Surgery ◽  
Transsphenoidal Pituitary Surgery ◽  
Complications And Mortality

Abstract INTRODUCTION Pituitary tumors are the second most common brain tumor (15.9%) in the United States. Transsphenoidal surgery is commonly indicated for pituitary tumors and few studies have investigated postoperative complications following this procedure. Our objective was to utilize the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to estimate the prevalence of and risk factors for complications following transsphenoidal pituitary surgery. METHODS Patients undergoing transsphenoidal surgery for pituitary tumor resection (CPT codes: 61 548, 62 165) from 2005 to 2015 were extracted from the ACS-NSQIP. The prevalence of postoperative complications was determined. Multivariable logistic regression was used to identify demographic, comorbid, and perioperative characteristics associated with any morbidity, severe (Clavien IV) complications, and mortality. RESULTS >Within 1177 transsphenoidal surgeries, there were 105 (8.92%) cases with at least one non-fatal complication, 29 (2.46%) cases with a severe complication, and 11 (0.93%) cases of mortality. The three most common complications were: reoperation (3.40%), transfusion (2.04%), and unplanned intubation (2.70%). In multivariable logistic regression analysis, the only significant predictors for postoperative complications were: 1) duration of surgery in hours for any morbidity (Odds Ratio [OR]: 1.30; 95% Confidence Interval [CI]: 1.15-1.46; P < 0.001), severe complications (OR: 1.38; 95% CI; 1.18-1.61; P < 0.001), and mortality (OR: 1.36; 95% CI: 1.11-1.67; P < 0.01); and 2) American Society of Anesthesiologists (ASA) class III-V for any morbidity (OR: 1.99; 95% CI: 1.23-3.21; P < 0.05) and severe complications (OR: 2.99; 95% CI: 1.13-7.94; P < 0.05). The area under the curve for any morbidity, severe complications, and mortality were 0.67, 0.74, and 0.77, respectively. CONCLUSION Transsphenoidal pituitary surgery is a relatively safe procedure with any morbidity occurring in approximately 1 in 10 patients and mortality occurring in approximately 1 in 100 patients. Our findings demonstrate duration of surgery and higher ASA classification is associated with increased risk for postoperative complications following transsphenoidal pituitary surgery.

scholarly journals Transient Exacerbation of Nasal Symptoms following Endoscopic Transsphenoidal Surgery for Pituitary Tumors: A Prospective Study

2017 ◽  
Vol 38 (03) ◽  
pp. 266-272 ◽  
Author(s):  
Benjamin Davies ◽  
Erica Tirr ◽  
Yi Wang ◽  
Kanna Gnanalingham
Keyword(s):  
Transsphenoidal Surgery ◽  
Temporal Evolution ◽  
Pituitary Tumors ◽  
Pituitary Surgery ◽  
Endoscopic Transsphenoidal Surgery ◽  
Rapid Reduction ◽  
Nasal Symptoms ◽  
Transsphenoidal Pituitary Surgery ◽  
A Prospective Study

Object Endoscopic transsphenoidal surgery is the commonest approach to pituitary tumors. One disadvantage of this approach is the development of early postoperative nasal symptoms. Our aim was to clarify the peak onset of these symptoms and their temporal evolution. Methods The General Nasal Patient Inventory (GNPI) was administered to 56 patients undergoing endoscopic transsphenoidal surgery for pituitary tumors preoperatively and at 1 day, 3 days, 2 weeks, 3 months, and 6 to 12 months postoperatively. Most patients underwent surgery for pituitary adenomas (N = 49; 88%) and through a uninostril approach (N = 55; 98%). Total GNPI (0–135) and scores for the 45 individual components were compared. Results GNPI scores peaked at 1 to 3 days postoperatively, with rapid reduction to baseline by 2 weeks and below baseline by 6 to 12 months postsurgery (p < 0.01). Of the 45 individual symptoms on the GNPI scale, 19 (42%) worsened transiently after surgery (p < 0.05). Functioning tumors had a higher GNPI scores at postoperative day 1 and 3 than nonfunctioning tumors, although their temporal evolution was the same (p < 0.05). Conclusions Nasal morbidity following endoscopic transsphenoidal pituitary surgery is common, but transient, more so in the functioning subgroup. Nasal symptoms improve below baseline by 6 to 12 months, without the need for specific long-term postoperative interventions in the vast majority of patients.

scholarly journals Endoscopic vs. microscopic transsphenoidal pituitary surgery: a single centre study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Morten Winkler Møller ◽  
Marianne Skovsager Andersen ◽  
Dorte Glintborg ◽  
Christian Bonde Pedersen ◽  
Bo Halle ◽  
...  
Keyword(s):  
Visual Impairment ◽  
Tumour Size ◽  
Pituitary Surgery ◽  
Endoscopic Technique ◽  
Electronic Patient Records ◽  
Beneficial Effects ◽  
Duration Of Surgery ◽  
Single Centre Study ◽  
Transsphenoidal Pituitary Surgery ◽  
Endoscopic Group

AbstractEndoscopic pituitary surgery has shown promising results. This study reports the experiences of experienced microscopic pituitary surgeons changing to the endoscopic technique, and the beneficial effects on the postoperative outcomes. 45 transsphenoidal endoscopic-assisted surgeries performed in 2016–2017 were compared with 195 microscope-assisted surgeries performed in 2007–2017 for pituitary adenoma. Tumour size, hormonal status and vision were assessed preoperatively and 3–5 months postoperatively. Cases were identified through electronic patient records. GTR was achieved in 39% of the endoscopic operations vs. 22% of microscopic operations, p = 0.018. Mean duration of surgery was 86 min (77–95) with the endoscopic technique vs. 106 min (101–111) with the microscopic technique, p < 0.001. New hypothalamus–pituitary–adrenal axis deficiencies were observed after 3% of endoscopic vs. 34% microscopic operations, p = 0.001, and overall fewer postoperative pituitary deficiencies were observed in the endoscope-assisted group. Complications within 30 days of surgery occurred in 17% of endoscopic operations vs. 27% of microscopic operations (p > 0.05). Normalization of visual impairment occurred in 37% of the cases with preoperative visual impairment in the endoscopic group vs. 35% of those in the microscopic group (p > 0.05). The endoscopic technique performed better as a surgical procedure for pituitary adenomas. We found no statistically significant differences in complication rate or visual improvement between the two techniques.

scholarly journals 4K 3-dimensional video microscope system (orbeye) for transsphenoidal pituitary surgery

2021 ◽  
Author(s):  
Roman Rotermund ◽  
Jan Regelsberger ◽  
Katharina Osterhage ◽  
Jens Aberle ◽  
Jörg Flitsch
Keyword(s):  
3D Visualization ◽  
Remission Rate ◽  
Subjective Evaluation ◽  
Pituitary Surgery ◽  
Image Resolution ◽  
Wide Range ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Video Microscope ◽  
Transsphenoidal Pituitary Surgery

Abstract Background In previous reports on experiences with an exoscope, this new technology was not found to be applicable for transsphenoidal pituitary surgery. As a specialized center for pituitary surgery, we were using a 4K 3D video microscope (Orbeye, Olympus) to evaluate the system for its use in transsphenoidal pituitary surgery in comparison to conventional microscopy. Method We report on 296 cases performed with the Orbeye at a single institution. An observational study was conducted with standardized subjective evaluation by the surgeons after each procedure. An objective measurement was added to compare the exoscopic and microscopic methods, involving surgery time and the initial postoperative remission rate in matched cohorts. Results The patients presented with a wide range of pathologies. No serious events or minor complications occurred based on the usage of the 4K 3D exoscope. There was no need for switching back to the microscope in any of the cases. Compared to our microsurgically operated collective, there was no significant difference regarding duration of surgery, complications, or extent of resection. The surgeons rated the Orbeye beneficial in regard to instrument size, positioning, surgeon’s ergonomics, learning curve, image resolution, and high magnification. Conclusions The Orbeye exoscope presents with optical and digital zoom options as well as a 4K image resolution and 3D visualization resulting in better depth perception and flexibility in comparison to the microscope. Split screen mode offers the complementary benefit of the endoscope which may increase the possibilities of lateral view but has to be evaluated in comparison to endoscopic transsphenoidal procedures in the next step.

scholarly journals Increased oxytocin release precedes hyponatremia after pituitary surgery

Pituitary ◽  
2021 ◽  
Author(s):  
Paul Eugène Constanthin ◽  
Nathalie Isidor ◽  
Sophie de Seigneux ◽  
Shahan Momjian
Keyword(s):  
Transsphenoidal Surgery ◽  
Pituitary Surgery ◽  
Sodium Balance ◽  
Posterior Pituitary ◽  
Axon Terminals ◽  
Early Marker ◽  
Inappropriate Secretion ◽  
Oxytocin Release ◽  
Transsphenoidal Pituitary Surgery ◽  
First Time

Abstract Purpose The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a well-known complication of transsphenoidal pituitary surgery, related to inappropriate secretion of arginine vasopressin (AVP). Its diagnosis is based on hyponatremia, with a peak of occurrence around day 7 after surgery and, to date, no early marker has been reported. In particular, copeptin levels are not predictive of hyponatremia in this case. Oxytocin (OXT) is secreted into the peripheral blood by axon terminals adjacent to those of AVP neurons in the posterior pituitary. Besides its role in childbirth and lactation, recent evidences suggested a role for OXT in sodium balance. The contribution of this hormone in the dysnatremias observed after pituitary surgery has however never been investigated. Methods We analyzed the urinary output of OXT in patients subjected to transsphenoidal pituitary surgery. Results While OXT excretion remained stable in patients who presented a normonatremic postoperative course, patients who were later diagnosed with SIADH-related hyponatremia presented with a significantly increased urinary secretion of OXT 4 days after surgery. Conclusion Taken together, these results show for the first time that urinary OXT output remains normally stable after transsphenoidal pituitary surgery. OXT excretion however becomes abnormally high on or around 4 days after surgery in patients later developing hyponatremia, suggesting that this abnormal dynamics of OXT secretion might serve as an early marker for transsphenoidal surgery-related hyponatremia attributed to SIADH.

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