Vascular Complications of Endoscopic Transsphenoidal Approach to Sellar Base Lesions

Abstract

Objective: Vascular complications are one of the most dangerous complications of endoscopic skull base surgeries. The aim of this study was to evaluate vascular complications of endoscopic transsphenoidal surgery in patients with sellar and parasellar lesions. Methods: Between August 1997 and July 2023, a total of 5300 patients underwent endoscopic transsphenoidal surgery for skull base lesions at Kocaeli University Faculty of Medicine, Department of Neurosurgery and Pituitary Research Center. Patients with vascular complications during and after surgery were included into the study. Results: We encountered 12 major vascular injuries, 116 epistaxis, and 50 operation site hematoma in our series. Conclusion: Major vascular injuries are the most life-threatening complicastions. They can cause high mortality. The ways to prevent these injuries seems to have high experience and to investigate preoperative vascular evaluation in detail.

Keywords

• Endoscopic transsphenoidal surgery
• complications
• vascular
• epistaxis
• cavernous sinus

Ethical Statement

07.09.2023 – GOKAEK-2023/14.35

References

1. Taghvaei M, Fallah S, Sadaghiani S, et al. Surgical complications of endoscopic approach to skull base: analysis of 584 consecutive patients. Eur Arch Oto-Rhino-Laryngology. 2022;279(6):3189-3199. doi:10.1007/s00405-022-07256-3.
2. Cappabianca P, Cavallo LM, De Divitiis E, Day JD, Ciric IS, Laws ER. Endoscopic endonasal transsphenoidal surgery. Neurosurgery. 2004;55(4):933-941. doi:10.1227/01.NEU.0000137330.02549.0D.
3. Tabaee A, Anand VK, Barrón Y, et al. Endoscopic pituitary surgery: A systematic review and meta-analysis: Clinical article. J Neurosurg. 2009;111(3):545-554. doi:10.3171/2007.12.17635.
4. Hattori Y, Tahara S, Aso S, et al. Pituitary surgery’s epidemiology using a national inpatient database in Japan. Acta Neurochir (Wien). 2020;162(6):1317-1323. doi:10.1007/s00701-020-04270-4.
5. Namvar M, Iranmehr A, Fathi MR, et al. Complications in Endoscopic Endonasal Pituitary Adenoma Surgery: An Institution Experience in 310 Patients. J Neurol Surgery, Part B Skull Base. 2022;84(3):255-265. doi:10.1055/a-1838-5897.
6. Sharma RK, Irace AL, Overdevest JB, Gudis DA. Carotid artery injury in endoscopic endonasal surgery: Risk factors, prevention, and management. World J Otorhinolaryngol - Head Neck Surg. 2022;8(1):54-60. doi:10.1002/wjo2.7.
7. Teramoto S, Tahara S, Murai Y, et al. Injury to the Extrasellar Portion of the Internal Carotid Artery during Endoscopic Transsphenoidal Surgery: A Case Report. Front Surg. 2022;9(May):1-6. doi:10.3389/fsurg.2022.895233.
8. Kassam AB, Prevedello DM, Carrau RL, et al. Endoscopic endonasal skull base surgery: Analysis of complications in the authors’ initial 800 patients - A review. J Neurosurg. 2011;114(6):1544-1568. doi:10.3171/2010.10.JNS09406. Alfieri A, Jho HD. Endoscopic endonasal approaches to the cavernous sinus: Surgical approaches. Neurosurgery. 2001;49(2):354-362. doi:10.1097/00006123-200108000-00017.

9. Ceylan S, Koc K, Anik I. Endoscopic endonasal transsphenoidal approach for pituitary adenomas invading the cavernous sinus. J Neurosurg. 2010;112(1):99-107. doi:10.3171/2009.4.JNS09182.
10. Ceylan S, Koc K, Anik I. Extended endoscopic approaches for midline skull-base lesions. Neurosurg Rev. 2009;32(3):309-319. doi:10.1007/s10143-009-0201-9.
11. Montagne W, Lloyd N, Sagalow E, Cox E, Hardman J, Kim J-H. Internal Carotid Artery Pseudoaneurysm After Transsphenoidal Pituitary Tumor Resection: A Case Report. Cureus. 2023;15(3). doi:10.7759/cureus.36539.
12. Ramachandran SN, Retnathankom A, Rege I, Reddy KT. Endovascular management of a sphenopalatine artery pseudoaneurysm: a rare cause of delayed intractable epistaxis following endoscopic transsphenoidal pituitary surgery. BMJ Case Rep. 2023;16(5):1-5. doi:10.1136/bcr-2022-253998.