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. 2023 Mar;165(3):685-692.
doi: 10.1007/s00701-022-05456-8. Epub 2023 Jan 20.

Remission, complications, and overall survival in transsphenoidal pituitary surgery-a Swedish single-center experience of 578 patients

Ola Fridman Bengtsson  1   2 , Ola Sunnergren  3 , Ivan Segerhammar  4 , Petter Förander  5 , Martin Olsson  5 , Anna-Lena Hulting  6 , Pär Stjärne  7   8
Affiliations

Remission, complications, and overall survival in transsphenoidal pituitary surgery-a Swedish single-center experience of 578 patients

Ola Fridman Bengtsson et al. Acta Neurochir (Wien). 2023 Mar.

Abstract

Background: Surgical treatment of pituitary lesions causing hormonal overproduction or mass effect is standard procedure. There are few reports on the results and complications related to these surgeries from Northern Europe. Our aim was to evaluate the outcome and complications of a single tertiary surgical center over more than a decade.

Methods: This was a retrospective study on all patients that underwent pituitary surgery from 1st of January 2005 to 31st of December 2017. The analysis included type of lesion, surgical method, pre- and postoperative need for hormonal substitution, hormonal outcome, complications to surgery, survival, need for revision surgery, or stereotactic radiation. Appropriate statistical analyses were made to evaluate surgical results, complications, and survival.

Results: Five hundred seventy-eight patients were included in the study. Remission was achieved in 58% of patients with GH-producing and 94% of ACTH-releasing adenomas. Sixty-six percent had no preoperative hormonal substitution compared to 39% postoperatively. Rhinosinusitis (10%) was the most commonly reported postoperative complication followed by leakage of cerebrospinal fluid (8%) and meningitis (4%). Standardized mortality rate for the study population was higher (p = 0.18) when compared to the general population.

Conclusion: Our results regarding remission rates and complications are in comparison with previous studies. Surgery of pituitary lesion can be considered a safe and efficient surgery. We noted lower rates of CSF leakage in the later part of the study period and believe that this, in part, was an effect by the introduction of a multidisciplinary surgical skull base team and increased surgical experience.

Keywords: Complications; Morbidity; Mortality; Pituitary surgery; Surgical results; Survival; Transsphenoidal.

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Figures

Fig. 1
Fig. 1
CSF leakage over time
Fig. 2
Fig. 2
Kaplan–Meier graph showing survival over time as compared to general population (n 578)
See this image and copyright information in PMC

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