Transnasal transsphenoidal pituitary surgery in a large tertiary hospital, a retrospective study.

Objectives Pituitary adenomas, although being small tumors, can have quite an impact on patients' lives causing hormonal and visual disturbances, for which surgery must be performed. As a large peripheral hospital with specialists in pituitary surgery, an assessment of the efficacy and safety of transnasal transsphenoidal pituitary surgery was made. Methods A retrospective analysis of neurosurgical reports as well as pre- and postoperative imaging was made to evaluate the presenting symptoms, tumoral variables, peri-operative morbidity, and long-term outcome. Results This cohort included 105 patients who were operated for pituitary adenomas over a 9-year period, with a slight male predominance. Adenomas had a mean maximum diameter of almost 25mm, with one-third of tumors presenting with a Knosp-grade 3 or 4. As expected, most patients presented with either visual (32.4%) or hormonal (40.0%) disturbances. After surgery, 85.3% had complete resolution of visual deficits, and 97.1% had normalisation of hormonal hypersecretion. Postoperative hormonal insufficiency requiring substitution was observed in 43.1% and was significantly more frequent in males and in non-functioning pituitary adenomas. Postoperative cerebrospinal fluid leakage was observed in 2.9%, and merely one patient developed meningitis. Tumor recurrence was significantly more frequent in patients with partial resection as compared to complete resection (25.6% vs 7.9%). Conclusion This study demonstrates that transnasal transsphenoidal pituitary surgery can be performed safely and effectively in a large non-university hospital, improving visual and/or hormonal disturbances as well as providing long-term tumor control. Patients with larger adenomas are at an increased risk to develop postoperative hypopituitarism.