Complications
In one systematic review and meta-analysis, a CSF leak was reported in 10% of patients who underwent transsphenoidal surgery for pituitary adenoma.[88] There was no significant difference between endoscopic and microscopic surgical techniques.
Occurs in 0.4% to 1.4% of patients after trans-sphenoidal surgery .[88]
Mortality occurs in 0.2%, typically with large tumours requiring craniotomy.[6]
Transient DI is seen in up to one third of patients after trans-sphenoidal surgery, but permanent DI occurs in 3% to 4%.[54]
Patients with hypopituitarism need to be diagnosed early and appropriately treated with hormone replacement. Hypopituitarism can be the result of tumour-compression or secondary to treatment of the adenoma. Surgery may induce a new hormone deficit in 2% to 15% of patients.[6] Hypopituitarism occurs in 30% to 60% of patients 5 to 10 years treated with conventional radiation therapy.[65] In patients treatment with stereotactic radiosurgery, the 5-year incidence of new or worsening pituitary deficits ranges from 10% to 40%.[65]
There may be further complications related to hypopituitarism (e.g., cardiovascular disease).
New neurological deficits occur in about 3% and are a cause of major morbidity.[89]
Extremely rare with conventional radiotherapy. Described in few cases of Gamma Knife radiosurgery. May be relatively more common with linear accelerator (LINAC) radiosurgery.[90]
Patients need to be closely followed by imaging studies, preferably MRI.
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