Complications of the Transnasal Transsphenoidal Approach to Sellar Tumors: A Single Institution's 5-Year Experience and Review of the Literature

Objectives: To describe our experience with all transnasal transsphenoidal microscopic approaches to sellar tumors in the last 5 years and examine its complication rate.

Design: Retrospective case note review and literature review.

Patients: In 126 patients, 152 consecutive transnasal transsphenoidal procedures were undertaken by three neurosurgeons in our center between 2006 and 2011. In the 118 case notes that were retrieved, 72 (61%) were men, and the average age was 55.5 years (range, 18–87 years). Reported histology showed adenoma (75%); craniopharyngioma (3.6%); Rathke's cleft cyst (2.1%); and <1% incidence of olfactory neuroblastoma, chondroma, chordoma, epidermoid, nerve sheath tumor, and infarcted pituitary. Ten percent of procedures were nondiagnostic.

Results: Complications included transient diabetes insipidus (DI) (20%), permanent DI (6.7%), postoperative CSF leak (7.8%), hyponatremia (7.8%), meningitis (1.4%), epistaxis (1.4%), and sinusitis (0.7%). Seven patients (5%) required operative repair of CSF leak. There were no operative deaths.

Twenty-nine of the patients underwent surgery for recurrent/residual tumor. Average time to redo surgery was 10.3 months, and the incidence was found to be higher in acromegalias (P < 0.05). Patients with postoperative transient DI were significantly less likely to require revision surgery (P < 0.05).

Conclusion: The overall complication rate of transnasal transsphenoidal procedures for sellar tumors is low. Recurrence may be more common with growth hormone–secreting adenomas. Postoperative transient DI may signify greater extent of tumor resection.

Our complication rate for CSF leak of 7.8% and for transient DI of 20% is consistent with rates reported in the literature (4%–13% and 5%–23%, respectively).