Early Postoperative Complications of Endoscopic Endonasal Transsphenoidal Surgery for Resection of Pituitary Adenoma


  • Taimoor Ali
  • Arshad Iqbal
  • Usman Haqqani




Sellar lesion


Objectives:  To determine early postoperative complications of endoscopic endonasal transsphenoidal surgery for resection of pituitary adenoma.


Materials and Methods:  This Descriptive Case Series was carried out at the Department of Neurosurgery, Lady Reading Hospital, MTI, Peshawar. 124 patients of either gender between the age of 16 – 60 were already diagnosed with cases of pituitary adenoma. Patients included in this study were surgically treated by Endoscopic endonasal transsphenoidal surgery. Patients were followed up for seven days after surgery and assessed for CSF leak, the incidence of diabetes insipidus epistaxis, and meningitis. Stratification was done for age and gender and p-value < 0.05 (chi-square).

Results:  CSF leak was observed in 2.4% (n = 3) of patients, diabetes insipidus was found in 11.3% (n = 14), Epistaxis in 1.6% (n = 2), and meningitis in 1.6% (n = 2) patients. No statistically substantial difference for both postoperative complications was observed based on gender and age-based stratification.

Conclusion:  Diabetes insipidus was a common early postoperative problem that was found in 11.3% of patients, CSF leak was found in 2.4%, epistaxis in 1.6% while meningitis in 1.6% of the cases following Endoscopic endonasal transsphenoidal surgery for pituitary adenomas. Though, there was not any statistically significant association found among different age groups and genders for complications studied.


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.

Zhong A, Pu J, Ruan L, Jin J, Tan S, Wang F, et al. The complications of endoscopic transsphenoidal surgery for pituitary neoplasms. Int J Clin Exp Med. 2016; 9 (10): 20026-31.

Fang J, Xie S, Li N, Jiang Z. Postoperative complications of endoscopic versus microscopic transsphenoidal pituitary surgery: a meta-analysis. Journal of the College of Physicians and Surgeons Pakistan, 2018; 28 (7): 554-60.

NisHioka H. Recent evolution of endoscopic endonasal surgery for treatment of pituitary adenomas. Neurologia medico-chirurgica. 2017; 57 (4): 151-8.

Charalampaki P, Ayyad A, Kockro RA, Perneczky A. Surgical complications after endoscopic transsphenoidal pituitary surgery. Journal of Clinical Neuroscience, 2009; 16 (6): 786-9.

Jho H-D. Endoscopic transsphenoidal surgery. Journal of neuro-oncology, 2001; 54: 187-95.

Cappabianca P, Cavallo LM, Solari D, Stagno V, Esposito F, de Angelis M. Endoscopic endonasal surgery for pituitary adenomas. World Neurosurgery, 2014; 82 (6): S3-S11.

Lin M, Wedemeyer MA, Bradley D, Donoho DA, Fredrickson VL, Weiss MH, et al. Long-term surgical outcomes following transsphenoidal surgery in patients with Rathke’s cleft cysts. Journal of Neurosurgery, 2018; 130 (3): 831-7.

Butenschoen VM, von Werder A, Bette S, Schmette V, Schwendinger N, Meyer B, Gempt J. Transsphenoidal pituitary adenoma resection: do early post-operative cortisol levels predict permanent long-term hypocortisolism? Neurosurgical Review, 2022: 1-10.

Chatzidakis S, Anagiotos A, Fotakopoulos G, Georgakopoulou VE, Tarantinos K, Papalexis P, Aravantinou Fatorou A, Sklapani P, Mathioudakis N, Trakas N, Spandidos DA. Comparison of the endoscopic endonasal to microscopic sublabial transsphenoidal approach in a case series of pituitary macroadenomas. Medicine International, 2023; 3 (1): 1-7.

Rutland JW, Dullea JT, Oermann EK, Feng R, Villavisanis DF, Gilja S, Shuman W, Lander T, Govindaraj S, Iloreta Jr AM, Chelnis J. Post-operative vision loss: analysis of 587 patients undergoing endoscopic surgery for pituitary macroadenoma. British Journal of Neurosurgery, 2022; 36 (4): 494-500.

Huo CW, King J, Goldschlager T, Dixon B, Zhao YC, Uren B, Wang YY. The effects of cerebrospinal fluid (CSF) diversion on post-operative CSF leak following extended endoscopic anterior skull base surgery. Journal of Clinical Neuroscience, 2022; 98: 194-202.

Akins PT, Ledgerwood LG, Duong HT. Early and late complications after open and endoscopic neurosurgery for complex skull base and craniofacial pathology: case series, illustrative cases, and review. Interdisciplinary Neurosurgery, 2022: 101552.






Original Articles