Introduction: Transsphenoidal pituitary surgery (TSPS) may be required either as a treatment for endocrinopathies or because of the risk or consequence of pituitary lesion expansion into adjacent structures, in particular optic chiasm compression. Published literature recommends surgery is performed by dedicated experienced surgeons with anticipated complication rates available as a comparator.
Methods: This retrospective audit included all patients diagnosed with a pituitary adenoma at Heartlands Hospital who subsequently had TSPS at University Hospital Coventry between 2012 and 2018. Data on endocrine, visual and operative complications was recorded and compared to assessment prior to TSPS.
Results: Of the 45 included patients the majority had non-functioning adenomas (NFA) (60%), additional surgical indications including acromegaly (24%), Cushings disease (2.4%) and macroprolactinomas not sufficient responsive to medical management (6.62%). 84% of adenomas were macroadneomas radiologically and 78% had normal anterior pituitary profile pre-op and 63% had normal fields. 40% developed a new anterior pituitary profile deficiency post-op and 13% developed transient diabetes insipidus. 4% developed new visual field defect, 7% had residual remnant, 7% had a new neurological deficit (external ocular nerve palsy, partial right 3rd nerve palsy), 2% epistaxis, 7% headache, 2% CSF leak and 2% post-surgical bleed. 64% did not develop any complications.
Conclusion: This data shows the advantage of a single surgeon service given the comparatively low complication rates seen compared to national and international comparator data. This audit is an important component of ongoing reflective surgical practise as well as providing support for our centres patient-based discussions of peri-operative risks.