ECE2024 Poster Presentations Pituitary and Neuroendocrinology (120 abstracts)
Complications of transphenoidal surgery for non-producing pituitary adenomas are not related to pretended surgical goals or surgical experience
Miguel Paja Fano 1 , Fernando Guerrero 2 , Dolores Moure 3 , Felicia Hanzu 4 , Betina Biagetti 5 , Almudena Vicente 6 , Rosa Cámara 7 , Andreu Simó 8 , Jose Recio 9 , Rocío Villar 10 , María Calatayud 11 , Silvia Aznar 12 , Marta Araujo-Castro 13 , Soledad Librizzi 13 , Angeles Gálvez 14 , Guillermo Serra 15 , Dolores Ollero 16 , Ana Irigaray 16 , Ana Delgado 17 , Paola Parra 18 , Patricia Martín 19 , Fernando Muñoz 20 , Anna Aulinas 21 , Rogelio García 22 , Isabel Ortiz 23 , Tomás González-Vidal 24 , Cristina Crespo 25 , Aina Raventós 26 , Javier Abarca 27 & Alfonso Soto 28
1Basurto University Hospital, Endocrinology; 2Hospital Universitari de Bellvitge, Endocrinology; 3Hospital Universitario de Cruces, Endocrinology; 4Hospital Clinic Barcelona, Endocrinology; 5Hospital Universitario Vall de Hebron, Endocrinology; 6Complejo Hospitalario de Toledo, Endocrinology; 7Hospital Universitari i Politècnic la Fe, Endocrinology; 8Hospital Universitario Mutua de Terrassa, Endocrinology; 9Hospital Universitario de Salamanca, Endocrinology; 10Complejo Hospitalario Universitario de Santiago, Endocrinology; 11Hospital Universitario 12 de Octubre, Endocrinology, Madrid, Spain; 12Complejo Hospitalario Universitario de Albacete, Endocrinology, Madrid, Spain; 13Hospital Universitario Ramon y Cajal, Endocrinology; 14Hospital Reina Sofía, Endocrinology; 15Hospital Son Espases, Endocrinology; 16Hospital Universitario de Navarra, Endocrinology; 17Hospital Universitario de Burgos, Endocrinology; 18Hospital Universitario La Paz, Endocrinology; 19Patricia Martín, Endocrinology; 20Hospital Sant Pau -Hospital del Mar, Neurosurgery; 21Hospital Sant Pau, Endocrinology; 22Hospital Gregorio Marañón, Endocrinology; 23Hospital Universitario Virgen de las Nieves, Neurosurgery; 24Hospital Universitario Central de Asturias, Endocrinology; 25Hospital Universitario Río Hortega, Endocrinology; 26Hospital German Trías i Pujol Badalona, Endocrinology; 27Hospital General Universitario de Alicante, Neurosurgery; 28Hospital Virgen del Rocío, Endocrinology
Surgical factors, in particular a higher volume of operations and a dedicated neurosurgeon, are considered the main determinants of surgical complication rates in transsphenoidal surgery (TSS). We evaluated postoperative complications in a large series of TSS for non-producing adenomas included in TESSPAIN, a retrospective multicenter nationwide registry. All TSS performed at the 29 participating centers between 2018 and 2022 were included. Globally, 1421 non-producing pituitary adenomas were included, representing 50,.5% of all TSS in these centers. An expert endocrinologist reviewed the feasibility of total pituitary adenoma resection in each case, and assessed outcome and permanent complications, including reoperation for bleeding or CSF leak, infection, anterior pituitary damage, permanent ADH deficiency, venous thromboembolism, cerebrovascular accident, death, cranial oculomotor or optic nerve damage, and others (including pneumocephalus, regrowth with second surgery and vasospasm). The most common reason for performing a TSS was optic nerve damage, which occurred in 615 cases (43.3%). Slightly more than half of the adenomas were considered amenable to total resection (n:759; 53.4%), which was achieved in 616 cases (81.2%). A quarter of the cases (n:355) had permanent surgical complications, the most common being additional antehypophyseal damage, which was reported in 16,8% of cases. Permanent ADH deficiency occurred in 91 cases (6.4%). Immediate reintervention due to bleeding, CSF leakage or vasospasm was required in fifty patients (3.5%). Forty-five cases (3.2%) presented with CSF leak on admission and 14 patients (1.0%) suffered cranial nerve damage as a complication of surgery. There were nine deaths related to TSS (0.63%), five cerebrovascular accidents and four thromboembolic events. The overall complication rate was not correlated with the number of surgeons performing TSS (mean rate: 25.9±16.9% vs 24.2±13.2% between centers with one or two dedicated neurosugeons vs more neurosurgeons; p: 0.77), nor with the total volume of TS surgeries during the study period (p: 0.91), nor with the number of non-producing pituitary adenomas operated on (p: 0.54). Only the rate of permanent ADH deficiency showed a trend towards a negative correlation with the cure rate of producing adenomas at the center evaluated (p: 0.08; r: -0.334). In conclusion, the rate of surgical complications reached 25% in a large series of TSS for non-producing pituitary adenomas, without apparent relation to surgical volume, number of neurosurgeons, or surgical goal of complete resection. These findings may be explained by the fact that more experienced centers assumed the most difficult cases and planned a stricter resection.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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