Short-Term Complications of Microscopic Trans Nasal Transsphenoidal Pituitary Adenomectomy


  • Samra Majeed Department of Neurosurgery, Services Hospital, Lahore
  • Sana Majeed
  • Muhammad Umair
  • Shahzaib Tasdique
  • Waqas Mehdi
  • Anjum Habib Vohra Surgimed Hospital, Lahore, Pakistan



Pituitary, Adenomectomy, Microscope, Trans-Sphenoidal


Background/Objective:   The commonest of pituitary gland tumors is pituitary adenoma which may be excised transcranially or trans nasal trans sphenoidal using either microscope or endoscope, in this study, the microscope was used. The objective was to see the short-term outcome of patients after microscopic transnasal trans-sphenoidal pituitary adenomectomy.

Material & Methods:  This was a descriptive prospective study carried out from July 2019 to July 2021. 80 cases were included. All patients were investigated by contrast brain MRI, hormonal assay for pituitary gland & visual perimetry. Patients were evaluated for complications at 48 hours and 7 days.

Results:  Mean age of the study population was 41.78 ± 11.75 years. There were 61 (76%) men & 19 (24%) women. 55 (68.8%) patients had functioning and 25 (3.3%) patients had nonfunctioning adenoma. Among 33 (41.3%) patients size of the adenoma was < 0.9 cm and 47 (58.8%) patients had adenoma > 1.0 cm. 12 patients had CSF leaks within 48 hours of surgery and 5 had a persistent leak on the 7th day. No statistically significant association was seen between age, gender, and size of adenoma and persistent CSF leak (P > 0.05). Diabetes insipidus was found in 9 patients. 3 had post-operative hematoma, 01 patient had meningitis and 2 patients died.

Conclusion:  microscopic transnasal trans-sphenoidal surgery is a safe procedure yet associated with significant complications.


Shamim MS, Khursheed F, Bari ME. Operating on master gland: 100 consecutive hypophysectomies at Aga Khan University Hospital, Karachi. Pak J Neurological Sci. 2006; 1: 66-9.

Wade AN, Baccon J, Grady MS, Judy KD, O’Rourke DM, Snyder PJ. Clinically silent somatotroph adenomas are common. European Journal of Endocrinology. 2011; 165 (1): 39-44.

Zada G, Woodmansee WW, Ramkissoon S, Amadio J, Nose V, Laws Jr ER. Atypical pituitary adenomas: incidence, clinical characteristics, and implications: Clinical article. Journal of Neurosurgery. 2011; 114 (2): 336-44.

Fernandez A, Karavitaki N, Wass JA. Prevalence of pituitary adenomas: a community?based, cross?sectional study in Banbury (Oxfordshire, UK). Clinical Endocrinology. 2010; 72 (3): 377-82.

Mezosi E, Nemes O. [Treatment of pituitary adenomas]. Orvosi Hetilap. 2009; 150 (39): 1803-10.

Asa SL. Practical pituitary pathology: what does the pathologist need to know? Archives of Pathology & Laboratory Medicine. 2008; 132 (8): 1231-40.

Richard GE ASaSL. Pituitary tumors: diagnosis and management In: Carrie RM NM, editor. Principles of Neurological surgery 3rd Ed: Elsevier; 2012: p. 627.

Vance ML. Treatment Of Pituitary Adenomas. [Online available from]:

Accessed Nov 2013.

Villwock JA, Villwock M, Deshaies E, Goyal P, editors. Significant increases of pituitary tumors and resections from 1993 to 2011. International Forum of Allergy & Rhinology, 2014: Wiley Online Library.

Kahilogullari G, Beton S, Al?Beyati ES, Kantarcioglu O, Bozkurt M, Kantarcioglu E, et al. Olfactory functions after transsphenoidal pituitary surgery: endoscopic versus microscopic approach. The Laryngoscope. 2013; 123 (9): 2112-9.

Fatemi N, Dusick JR, de Paiva Neto MA, Kelly DF. The endonasal microscopic approach for pituitary adenomas and other parasellar tumors: a 10?year experience. Neurosurgery. 2008; 63 (4): 244-56.

Benveniste RJ, King WA, Walsh J, Lee JS, Delman BN, Post KD. Repeated transsphenoidal surgery to treat recurrent or residual pituitary adenoma. Journal of Neurosurgery. 2005; 102 (6): 1004-12.

Mortini P, Losa M, Barzaghi R, Boari N, Giovanelli M. Results of transsphenoidal surgery in a large series of patients with pituitary adenoma. Neurosurgery. 2005; 56 (6): 1222-33.

Hobbs C, Darr A, Carlin W. Management of intra-operative cerebrospinal fluid leak following endoscopic trans-sphenoidal pituitary surgery. The Journal of Laryngology & Otology. 2011; 125 (03): 311-3.

Jane Jr JA, Thapar K, Kaptain GJ, Maartens N, Laws Jr ER. Pituitary surgery: transsphenoidal approach. Neurosurgery. 2002; 51 (2): 435-44.

Laws Jr ER, Fode NC, Redmond MJ. Transsphenoidal surgery following unsuccessful prior therapy: An assessment of benefits and risks in 158 patients. Journal of Neurosurgery. 1985; 63 (6): 823-9.

Ciric I, Ragin A, Baumgartner C, Pierce D. Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery. 1997; 40 (2): 225-37.

Seiler RW, Mariani L. Sellar reconstruction with resorbable vicryl patches, gelatin foam, and fibrin glue in transsphenoidal surgery: a 10-year experience with 376 patients. Journal of Neurosurgery. 2000; 93 (5): 762-5.

Jung H, Shah A, Ajlan A. Perioperative Cerebrospinal Fluid Diversion Utilizing Lumbar Drains in Transsphenoidal Surgery. Journal of Neurological Disorders. 2014.

Gao Y, Zhong C, Wang Y, Xu S, Guo Y, Dai C, et al. Endoscopic versus microscopic transsphenoidal pituitary adenoma surgery: a meta-analysis. World Journal of Surgical Oncology. 2014; 12 (1): 1-12.

Razak AA, Horridge M, Connolly DJ, Warren DJ, Mirza S, Muraleedharan V, et al. Comparison of endoscopic and microscopic trans-sphenoidal pituitary surgery: early results in a single centre. British Journal of Neurosurgery. 2013; 27 (1): 40-3.

Chowdhury T, Prabhakar H, Bithal PK, Schaller B, Dash HH. Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study. Saudi Journal of Anaesthesia. 2014; 8 (3): 335–341.

Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA. Classical pituitary apoplexy: Clinical features, management and outcome. Clin Endocrinol (Oxf). 1999; 51: 181–8.

Persky MS, Brunner E, Copper PR, Cohen NL. Perioperative complication of transsphenoidal excision for pituitary adenomas. Skull Base Surgery. 1996; 6: 231–5.