Outcomes and complications of endoscopic pituitary surgery: A single-center study

Rocio Villar Taibo; Santamaría Nieto Alicia; Andújar Plata Paula; Fernández Pombo Antía; Gemma Rodríguez Carnero María; Bernabeu Morón Ignacio

doi:10.1530/endoabs.73.AEP521

Objectives

To present the results of our series of endoscopic surgery of PA, performed in a third level hospital by an experienced team.

Methods

Retrospective review of PA undergoing endoscopic surgery between 2011 – 2018 in our institution. Clinical variables and radiological characteristics and outcomes were collected at diagnosis, before surgery and for an average of 4.8 years of postoperative follow-up.

Results

121 patients with PA and endoscopic surgery were identified. Table 1 summarises baseline characteristics.

**Table 1**
Age at surgery (years)	57.8 ± 17
Sex (n male)	64 (52.9%)
Charlson Index score	2 (0-10)
Clinical presentation (at diagnosis) - Incidental - Hypopituitarism - Apoplexy - Compressive symptoms - Visual impairment	43 (35.5%) 65 (53.7%) 13 (10.7%) 51 (42.1%) 38 (31.4%)
Non-functioning adenoma Functioning adenoma - GH-secreting - ACTH-secreting - PRL-secreting - TSH-secreting	78 (35.5%) 43 (64.5%) 26 (21.4%) 11 (9.0%) 5 (4.1%) 1 (0.8%)
Tumour characteristics - Tumour size - Macroadenoma - Maximum diameter (mm) - Extrasellar extension - Suprasellar - Sphenoidal - Cavernous sinus invasion - Knosp >3	102 (84.3%) 22.3 ± 11.0 92 (76.0%) 86 (71.1%) 20 (16.5%) 47 (38.8%) 28 (23.1%)

Data are n (%) values, mean ± SD or median (IQR).

Surgical evolution and post-surgical outcomes are shown in Table 2.

**Table 2**
Surgery indications - Functioning adenoma - Compressive symptoms - Large tumour size - Apoplexy - Resistance to medical treatment	41 (33.9%) 40 (33.1%) 30 (24.8%) 8 (6.3%) 2 (1.6%)
Complications: Intraoperative - CSF leak - Intracranial haemorrhage - Epistaxis Immediate postoperative (1st week after surgery) - DI - Infection - Epistaxis - CSF leak - Other Late postoperative - DI - Infection - CSF leak - Other	4 (3.3%) 1 (0.8%) 2 (1.6%) 1 (0.8%) 35 (28.9%) 13 (10.7%) 5 (4.1%) 4 (2.8%) 3 (3.3%) 10 (8.2%) 16 (13.2%) 7 (5.7%) 2 (1.6%) 1 (0.8%) 6 (4.9%)
Hospital stay (days)	7.3 ± 6.0
Postoperative status - Visual field improvement - Hormone excess normalization - Hypopituitarism - Macroscopic total resection - Absence of tumor rest (RM/TC)	25/38 (65, 7%) 22/43 (51, 1%) 65 (53, 7%) 86 (71, 1%) 82 (67, 8%)
Final visit outcomes - Reintervention - Radiotherapy - Remission - Death	19 (15.7%) 14 (11.5%) 76 (62.8%) 3 (2.5%)

Conclusion

Endoscopic pituitary surgery appears to be safe and effective when an experienced pituitary team is available.

Endocrine Abstracts

AEP521