Managing complications of endoscopic transsphenoidal surgery in pituitary adenomas

Kumar Abhinav, Matthew Tyler, Oliver T. Dale, Ahmed Mohyeldin, Juan C. Fernandez-Miranda, Laurence Katznelson

Research output: Contribution to journalReview articlepeer-review

9 Scopus citations


INTRODUCTION: Over the last two decades there has been a gradual shift from the traditional microscopic approach toward the use of endoscopic endonasal approach for resection of pituitary adenomas. Multiple medical and surgical complications can occur following endoscopic transsphenoidal resection of adenomas.

AREAS COVERED: We discuss the evolution of the surgical practice from the use of the 'microscope' to the 'endoscope' in the resection of pituitary adenomas. We present a comprehensive review of the medical and surgical complications following surgery with particular emphasis on both the prevention and management of electrolyte disturbance, cerebrospinal fluid leak and the rare but dreaded complication of internal carotid injury (ICA). We also searched the PubMed database to identify relevant literature between 1984 and 2019.

EXPERT OPINION: Use of endoscope compared with microscope may be associated with better preservation of pituitary gland function with similar extent of resection. Overall medical and surgical complications can be safely managed in high volume centers in association with endocrinologists and skull base trained otolaryngologists. Understanding of anatomico-technical nuances and meticulous surgical technique are important toward preventing ICA injury. Ongoing surgical and technical developments coupled with imaging advances will likely lead to better future outcomes for patients with functioning and nonfunctioning adenomas.

Original languageEnglish (US)
Number of pages9
JournalExpert Review of Endocrinology and Metabolism
Issue number5
StatePublished - Sep 2020

Bibliographical note

Publisher Copyright:
© 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group.


  • ICA injury
  • Pituitary adenoma
  • cerebrospinal fluid leak
  • complications
  • endoscopic endonasal approach
  • hypopituitarism

PubMed: MeSH publication types

  • Journal Article
  • Review


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