Frequency of Early Complications of Trans-sphenoidal Surgery

Authors

  • SEEMA SHARAFAT Department of Neurosurgery Lady Reading
  • ZAHID KHAN Department of Neurosurgery Lady Reading
  • MUMTAZ ALI Department of Neurosurgery Lady Reading
  • Mohammad Siddique Department of Neurosurgery Lady Reading Hospital
  • Farooq Azam Department of Neurosurgery Lady Reading Hospital,

Keywords:

Pituitary adenomas, Tran’s nasal trans-sphenoidal surgery;, postoperative complications, diabetes Insipidus, CSF leak;, meningitis

Abstract

Objective: To determine the frequency of early complication of trans-nasal trans-sphenoidal surgery for pituitary adenoma.
Material and Methods: This observational study was conducted at the department of Neurosurgery, Post-graduate medical institute, Lady Reading Hospital Peshawar from June 2009 to December 2010. A total of 63 consecutive patients who undergone Trans nasal trans-sphenoidal surgery for pituitary adenoma with age more than fourteen years were included in the study irrespective of their gender. These patients were followed up to 7 post op days for early complications and frequency of these complications was calculated.
Results: Out of 63 patients, there were 52.4% males and 47.6% females. Majority (34.9%) of patients were in the age range of 31 – 40 years, followed by 28.6% patients in age group of 21 – 30 years. Among early post-operative complications diabetes Insipidus was noted in 7.9% cases, Postoperative CSF leak was recorded in 4.8% cases and meningitis was observed in 1.6% case.
Conclusions: We conclude that most of our patients with pituitary adenoma were males in their 3rd or 4th decades of life. Diabetes Insipidus was the most common early post-operative complication followed by CSF leak and meningitis.

References

1. Shamim MS, Khursheed F, Bari ME. Operating on the master gland: 100 consecutive Hypophysectomies at Aga Khan University Hospital, Karachi. Pak J Neuro-log Sci, 2006; 1: 66-9.
2. Ikram MF, Sajjad Z, Shokh IS, Omair A. Pituitary gland volume on magnetic resonance imaging: norma-tive observations. Pak J Neurolog Sci, 2007; 2: 141-4.
3. Chaudhry MU. A 60 – year – old man with progressive malaise, fatigue and decreased libido. Can Med Assoc J, 2003; 169: 445.
4. Serri O, Chik CL, Ehud U, Ezzat S. Diagnosis and man-agement of hyper-prolactinemia. Can Med Assoc J, 2003; 169: 575-81.
5. Laufer I, Anand VK, Schwartz TH. Endoscopic, endo-nasal extended trans-sphenoidal, trans-planum trans-tuberculum approach for resection of suprasellar les-ions. J Neurosurg, 2007; 106: 400-6.
6. Cavallo LM, Dal Fabbro M, Jalalod'din H, Messina A, Esposito I, Esposito F, et al. Endoscopic endonasal trans-sphenoidal surgery. Before scrubbing in: tips and tricks. Surg Neurol, 2007; 67: 342-7.
7. Charalampaki P, Reisch R, Ayad A, Conrad J, Wels-chehold S, Perneczky A, et al. Endoscopic endonasal8. Schmidek HH, Roberts DW. Schmidek and Sweet Ope-rative neurosurgical technique. In: Swearingen B, ed. Trans-sphenoidal approach to pituitary tumors. 5th ed. New York: Saunders Elsevier, 2006: 321-5.
9. Esposito F, Dusick JR, Fatemi N, Kelly DF. Graded repair of cranial base defects and cerebrospinal fluid leaks in trans-sphenoidal surgery. Neurosurgery, 2007; 60: 295-303.
10. Dusick JR, Esposito F, Malkasian D, Kelly DF. Avoi-dance of carotid artery injuries in trans-sphenoidal surgery with the Doppler probe and micro-hook blades. Neurosurgery, 2007; 60: 322-8.
11. Nielsen EH, Lindholm J, Laurberg P, Bjerre P, Christi-ansen JS, Hagen C, et al. Nonfunctioning pituitary ade-noma: incidence, causes of death and quality of life in relation to pituitary function. Pituitary, 2007; 10: 67-73.
12. Sudhakar N, Ray A, Vafidis JA. Complications after trans-sphenoidal surgery: our experience and a review of the literature. Br J Neurosurg, 2004; 18: 507-12.
13. Sangeetha SR, Singh N, Vender JR, Dhandapani KM. Suberoylanilidehydroxamic acid (SAHA) induces gro-wth arrest and apoptosis in pituitary adenoma cells. Endocrine, 2009; 35: 389-96.
14. Losa M, Gioia L, Picozzi P, Franzin A, Valle M, Gio-vanelli M, et al. The role of stereotactic radiotherapy in patients with growth hormone – secreting pituitary ade-noma. J Clin Endocrinol Metab, 2008; 93: 2546-52.
15. Fujimura M, Ikeda H, Takahashi A, Ezura M, Yoshi-moto T, Tominaga T. Diagnostic value of super – selec-tive bilateral cavernous sinus sampling with hypothala-mic stimulating hormone loading in patients with AC-TH – producing pituitary adenoma. Neurol Res, 2005; 27: 11-5.
16. Mulinda J R. Pituitary macroadenomas. [Online] 2009 [Cited on September 13, 2009]. Available from:
URL://htpp://www.emedicine.medscape.com/endocrinology_pituitary_adenomas.html
17. Shahid K, Iqbal N. HRCT of pituitary fossa correlation of clinical and CT findings. Ann King Edward Med Coll, 2007; 13: 48-50.
18. Asif M, Ahmed M, Ahmed N, Raja IA. Pituitary tumors: clinical presentation. Pak J Neurol 1998; 4: 39-41.
19. Khan AN, Turnbull I, Rudralingam V, Alonso A, James A, Munusamy S, et al. Pituitary Adenoma: imaging. (Online) 2009 (Cited on September 13, 2009).
Available from: URL://htpp://www.emedicine.medscape.com/radiology_pituitary_adenoma.html.
20. Nemergut EC. Peri-operative management of patient undergoing trans-sphenoidal pituitary surgery. Anesth Analg 2005; 101: 1170-81.
21. Kristoe RA, Rother M, Neuloh G, Klingmaller D. Inci-dence, clinical manifestations, and course of water and electrolyte metabolism disturbances following trans-sphenoidal pituitary adenoma surgery: a prospective observational study. J Neurosurg, 2009; 111: 555-62.
22. Woods C, Thompson CJ. Risk of diabetes insipidus after pituitary surgery. Expert Rev Endocrinol Metabol 2008; 3: 23-7.
23. Robertson HJF, Palacios E, D'Antonio MG. Cerebrospi-nal fluid, leak. [Online] 2009 [Cited on October 02, 2009]. Available from:
URL://htpp://www.emedicine.medscape.com/radiology_cerebrospinal_fluid.html
24. Zhao B, Wei Yk, Li YN, Yao Y, Kang J. Extended TSS approach for pituitary adenoma invading the anterior cranial base, cavernous sinus and clivus: a single expe-rience with 126 consecutive cases. Neurosurgery 2010; 112: 108-7.
25. Bernal S, Alobid I, Mullol J, Trobat F, Prekel M. Clo-sure of CSF leaks prevents ascending bacterial menin-gitis, 2005; 43: 277-81.
26. Baker F, Klibanski A, Swearigen B. trans-sphenoidal surgery for pituitary tumors in United States, 1996 – 2000: mortality, morbidity, and effects of hospital and surgeon volume. J Clin Endocrinol Metabol 2003; 88: 4709-19.
27. Barzaghi LR, Losa M, Giovanelli M, Mortini P. Comp-lications of trans-sphenoidal surgery in patients with pituitary adenoma: experience at a single centre. Acta Neurochir (Wien) 2007; 149: 877-86.

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2018-09-30

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