Article
Complications of sellar surgery
Komplikationen bei Operationen sellärer Prozesse
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Outline
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Objective
To prospectively analyze complications of surgical treatment of intra- and suprasellar lesions.
Methods
From 1999 to 2004, perioperative complications of surgical treatment of sellar lesions were prospectively documented. 175 consecutive patients with intra- and/or suprasellar pathology were analyzed with regard to clinical presentation, histological diagnosis, operative parameters and perioperative morbidity.
Results
The majority of patients harboured pituitary adenomas (n=121; 69%), which were mostly treated transsphenoidally (93%). Sellar meningiomas comprised the second largest patient group (n=26) and were treated almost exclusively via a transcranial approach (96%). Other entities, like chordomas, pituitary metastasis, cysts, etc., were either approached transsphenoidally or transcranially. Mean duration of surgery amounted to 96±33 min for transsphenoidal procedures and to 237±106 min for transcranial procedures. There was no perioperative mortality. Transsphenoidal procedures were complicated by CSF fistula (2%) and postoperative hemorrhage in elderly patients in particular with incomplete tumour resection (3%). Temporary cranial nerve palsy and temporary diabetes insipidus were seen with both approaches (3% each). Deterioration of vision occurred in 16% after transcranial surgery, and affected mostly meningioma patients (6 of 26 patients; 23%). Interestingly, in 3 of these patients, visual impairment developed with some delay indicating (micro-)vascular dysfunction. Transcranial surgery was also complicated by rare adverse events like hemiparesis (n=1), cerebral vasospasm (n=1) and temporary memory disturbance (n=1). Overall rate of temporary and permanent morbidity was 11% and 1% for transsphenoidal procedures and 32% and 16% for transcranial procedures, respectively.
Conclusions
Transsphenoidal surgery of sellar lesions demonstrates very low rates of permanent morbidity. Transcranial surgery, however, can be associated with significant morbidity and rare complications. Especially visual impairment after removal of suprasellar meningiomas remains a major concern and may be attributed to microvascular compromise.
