Complications in a contemporary series of patients who underwent transsphenoidal surgery for Cushing's disease

Patrick L. Semple F.C.S.(SA), M.Med.1 and Edward R. Laws Jr. M.D.1
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  • 1 Department of Neurosurgery, University of Cape Town, Cape Town, South Africa; and Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia
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Object. Transsphenoidal surgery is the usual treatment of choice for adrenocorticotropic hormone—secreting pituitary adenomas associated with Cushing's disease. In this paper the authors investigate the complications of transsphenoidal surgery in the treatment of a contemporary series of patients with Cushing's disease.

Methods. Between January 1992 and December 1997, 105 patients with Cushing's disease underwent transsphenoidal surgery at the University of Virginia Health Sciences Center. A retrospective analysis of the complications was conducted, and the mortality rate was found to be 0.9% and permanent morbidity was 1.8%. The overall number of complications was 14 (13.3%), which included seven complications directly related to surgery; one instance of permanent diabetes insipidus; one syndrome of inappropriate secretion of antidiuretic hormone; and five medical complications (four patients developed deep vein thrombosis and one developed pneumonia).

Conclusions. Transsphenoidal surgery for Cushing's disease has a higher complication rate than that for pituitary adenomas in general. This is primarily related to a greater number of medical complications, most notably deep vein thrombosis, resulting from the generally debilitated state of most patients with Cushing's disease. In view of the high incidence of deep vein thrombosis in these patients, prophylaxis for thromboembolism during the perioperative period is recommended.

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  • 1.

    Barrow DL, & Tindall GT: Loss of vision after transsphenoidal surgery. Neurosurgery 27:6068, 1990 Barrow DL, Tindall GT: Loss of vision after transsphenoidal surgery. Neurosurgery 27:60–68, 1990

    • Search Google Scholar
    • Export Citation
  • 2.

    Black PM, , Zervas NT, & Candia GL: Incidence and management of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery 20:920924, 1987 Black PM, Zervas NT, Candia GL: Incidence and management of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery 20:920–924, 1987

    • Search Google Scholar
    • Export Citation
  • 3.

    Ciric I, , Ragin A, & Baumgartner C, et al: Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40:225237, 1997 Ciric I, Ragin A, Baumgartner C, et al: Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40:225–237, 1997

    • Search Google Scholar
    • Export Citation
  • 4.

    Cusick JF, , Hagen TC, & Findling JW: Inappropriate secretion of antidiuretic hormone after transsphenoidal surgery for pituitary tumors. N Engl J Med 311:3638, 1984 Cusick JF, Hagen TC, Findling JW: Inappropriate secretion of antidiuretic hormone after transsphenoidal surgery for pituitary tumors. N Engl J Med 311:36–38, 1984

    • Search Google Scholar
    • Export Citation
  • 5.

    Eljamel MS: Antibiotic prophylaxis in unrepaired CSF fistulae. Br J Neurosurg 7:501506, 1993 Eljamel MS: Antibiotic prophylaxis in unrepaired CSF fistulae. Br J Neurosurg 7:501–506, 1993

    • Search Google Scholar
    • Export Citation
  • 6.

    Fahlbusch R, , Buchfelder M, & Müller OA: Transsphenoidal surgery for Cushing's disease. J R Soc Med 79:262269, 1986 Fahlbusch R, Buchfelder M, Müller OA: Transsphenoidal surgery for Cushing's disease. J R Soc Med 79:262–269, 1986

    • Search Google Scholar
    • Export Citation
  • 7.

    Haile-Mariam T, , Laws ER Jr, & Tuazon CU: Gram-negative meningitis associated with transsphenoidal surgery: case reports and review. Clin Inf Dis 18:553556, 1994 Haile-Mariam T, Laws ER Jr, Tuazon CU: Gram-negative meningitis associated with transsphenoidal surgery: case reports and review. Clin Inf Dis 18:553–556, 1994

    • Search Google Scholar
    • Export Citation
  • 8.

    Hamilton MG, , Hull RD, & Pineo GF: Venous thromboembolism in neurosurgery and neurology patients: a review. Neurosurgery 34:280296, 1994 Hamilton MG, Hull RD, Pineo GF: Venous thromboembolism in neurosurgery and neurology patients: a review. Neurosurgery 34:280–296, 1994

    • Search Google Scholar
    • Export Citation
  • 9.

    Hensen J, , Buchfelder M, & Henig A, et al: Disturbances of osmoregulation in the neurosurgical setting—with special emphasis on the situation after surgery for pituitary tumors, in von Werder K, & Fahlbusch R (eds): Pituitary Adenomas: From Basic Research to Diagnosic and Therapy. Amsterdam: Elsevier, 1996, pp 255268 Hensen J, Buchfelder M, Henig A, et al: Disturbances of osmoregulation in the neurosurgical setting—with special emphasis on the situation after surgery for pituitary tumors, in von Werder K, Fahlbusch R (eds): Pituitary Adenomas: From Basic Research to Diagnosic and Therapy. Amsterdam: Elsevier, 1996, pp 255–268

    • Search Google Scholar
    • Export Citation
  • 10.

    Kelly DF, , Laws ER Jr, & Fossett D: Delayed hyponatremia after transsphenoidal surgery for pituitary adenoma. Report of nine cases. J Neurosurg 83:363367, 1995 Kelly DF, Laws ER Jr, Fossett D: Delayed hyponatremia after transsphenoidal surgery for pituitary adenoma. Report of nine cases. J Neurosurg 83:363–367, 1995

    • Search Google Scholar
    • Export Citation
  • 11.

    Landolt AM: Transsphenoidal surgery of pituitary tumors: its pitfalls and complications, in de Villiers JC (ed): Some Pitfalls and Problems in Neurosurgery. Progress in Neurological Surgery, Vol 13. Basel: Karger, 1990, pp 130 Landolt AM: Transsphenoidal surgery of pituitary tumors: its pitfalls and complications, in de Villiers JC (ed): Some Pitfalls and Problems in Neurosurgery. Progress in Neurological Surgery, Vol 13. Basel: Karger, 1990, pp 1–30

    • Search Google Scholar
    • Export Citation
  • 12.

    Laws ER Jr: Complications of surgery for ACTH secreting tumors, in Lüdecke DK, , Chrousus GP, & Tolis G (eds): ACTH, Cushing's Syndrome, and Other Hypercortisolemic States. Progress in Endocrine Research and Therapy, Vol 5. New York: Raven Press, 1990, pp 275280 Laws ER Jr: Complications of surgery for ACTH secreting tumors, in Lüdecke DK, Chrousus GP, Tolis G (eds): ACTH, Cushing's Syndrome, and Other Hypercortisolemic States. Progress in Endocrine Research and Therapy, Vol 5. New York: Raven Press, 1990, pp 275–280

    • Search Google Scholar
    • Export Citation
  • 13.

    Laws ER Jr: Complications of transsphenoidal microsurgery for pituitary adenomas. Mod Neurosurg 1:181185, 1982 Laws ER Jr: Complications of transsphenoidal microsurgery for pituitary adenomas. Mod Neurosurg 1:181–185, 1982

    • Search Google Scholar
    • Export Citation
  • 14.

    Laws ER Jr: Pituitary surgery. Endocrinol Metab Clin North Am 16:647665, 1987 Laws ER Jr: Pituitary surgery. Endocrinol Metab Clin North Am 16:647–665, 1987

    • Search Google Scholar
    • Export Citation
  • 15.

    Laws ER Jr, , Abboud CF, & Kern EB: Perioperative management of patients with pituitary microadenoma. Neurosurgery 7:566570, 1980 Laws ER Jr, Abboud CF, Kern EB: Perioperative management of patients with pituitary microadenoma. Neurosurgery 7:566–570, 1980

    • Search Google Scholar
    • Export Citation
  • 16.

    Laws ER Jr, & Kern EB: Complications of transsphenoidal surgery, in Laws ER Jr, , Randall RV, & Kern EB, et al (eds): Management of Pituitary Adenomas and Related Lesions With Emphasis on Transsphenoidal Microsurgery. New York: Appleton-Century-Crofts, 1982, pp 329346 Laws ER Jr, Kern EB: Complications of transsphenoidal surgery, in Laws ER Jr, Randall RV, Kern EB, et al (eds): Management of Pituitary Adenomas and Related Lesions With Emphasis on Transsphenoidal Microsurgery. New York: Appleton-Century-Crofts, 1982, pp 329–346

    • Search Google Scholar
    • Export Citation
  • 17.

    Laws ER Jr, & Thapar K: Surgical management of pituitary adenomas. Bailliere's Clin Endocrinol Metab 9:391405, 1995 Laws ER Jr, Thapar K: Surgical management of pituitary adenomas. Bailliere's Clin Endocrinol Metab 9:391–405, 1995

    • Search Google Scholar
    • Export Citation
  • 18.

    Mampalam TJ, , Tyrrell JB, & Wilson CB: Transsphenoidal microsurgery for Cushing's disease. A report of 216 cases. Ann Intern Med 109:487493, 1988 Mampalam TJ, Tyrrell JB, Wilson CB: Transsphenoidal microsurgery for Cushing's disease. A report of 216 cases. Ann Intern Med 109:487–493, 1988

    • Search Google Scholar
    • Export Citation
  • 19.

    Matsuno A, , Yoshida S, & Basugi N, et al: Severe subarachnoid hemorrhage during transsphenoidal surgery for pituitary adenoma. Surg Neurol 39:276278, 1993 Matsuno A, Yoshida S, Basugi N, et al: Severe subarachnoid hemorrhage during transsphenoidal surgery for pituitary adenoma. Surg Neurol 39:276–278, 1993

    • Search Google Scholar
    • Export Citation
  • 20.

    Murty GE, , Lamballe P, & Welch AR: Early inappropriate secretion of antidiuretic hormone after trans-sphenoidal pituitary adenomectomy. J Laryngol Otol 104:894895, 1990 Murty GE, Lamballe P, Welch AR: Early inappropriate secretion of antidiuretic hormone after trans-sphenoidal pituitary adenomectomy. J Laryngol Otol 104:894–895, 1990

    • Search Google Scholar
    • Export Citation
  • 21.

    Raymond J, , Hardy J, & Czepko R, et al: Arterial injuries in transsphenoidal surgery for pituitary adenoma: the role of angiography and endovascular treatment. AJNR 18:655665, 1997 Raymond J, Hardy J, Czepko R, et al: Arterial injuries in transsphenoidal surgery for pituitary adenoma: the role of angiography and endovascular treatment. AJNR 18:655–665, 1997

    • Search Google Scholar
    • Export Citation
  • 22.

    Sheeler LR: Cushing's syndrome—1988. Cleve Clin J Med 55:329337, 1988 Sheeler LR: Cushing's syndrome—1988. Cleve Clin J Med 55:329–337, 1988

    • Search Google Scholar
    • Export Citation
  • 23.

    Thapar K, & Laws EB: Complications and outcome of transsphenoidal microsurgery in ACTH-secreting adenomas. J Neurosurg 76:372A, 1992 (Abstract) Thapar K, Laws EB: Complications and outcome of transsphenoidal microsurgery in ACTH-secreting adenomas. J Neurosurg 76:372A, 1992 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 24.

    Ultmann MC, , Hoffman GE, & Nelson PB, et al: Transient hyponatremia after damage to the neurohypophyseal tracts. Neuroendocrinology 56:803811, 1992 Ultmann MC, Hoffman GE, Nelson PB, et al: Transient hyponatremia after damage to the neurohypophyseal tracts. Neuroendocrinology 56:803–811, 1992

    • Search Google Scholar
    • Export Citation
  • 25.

    Van Aken MO, , de Marie S, & van der Lely AJ, et al: Risk factors for meningitis after transsphenoidal surgery. Clin Infect Dis 25:852856, 1997 Van Aken MO, de Marie S, van der Lely AJ, et al: Risk factors for meningitis after transsphenoidal surgery. Clin Infect Dis 25:852–856, 1997

    • Search Google Scholar
    • Export Citation

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