Operative Strategies to Minimize Complications Following Resection of Pituitary Macroadenomas.

We sought to identify factors associated with increased length of stay (LOS) and morbidity in patients undergoing resection of pituitary macroadenomas.  We reviewed records of 203 consecutive patients who underwent endoscopic endonasal resection of a pituitary macroadenoma (mean age = 55.7 [16-88]) years, volume = 11.3 (1.0-134.3) cm. Complete resection was possible in 60/29.6% patients. Mean follow-up was 575 days. Multivariate logistic regression was performed using MATLAB.  Mean LOS was 4.67 (1-66) days and was associated with CSF leak ( = 0.025), lumbar drain placement ( = 0.041;  = 8/3.9% intraoperative,  = 20/9.9% postoperative), and any infection ( = 0.066). Age, diabetes insipidus ( = 17/8.37%), and syndrome of inappropriate antidiuretic hormone secretion ( = 12/5.9%) were not associated with increased LOS ( > 0.2). Postoperative CSF leak in the hospital ( = 21/10.3%) was associated with intraoperative CSF leak ( = 0.002;  = 82/40.4%) and complete resection ( = 0.012). There was no significant association ( > 0.1) between postoperative CSF leak in the hospital following surgery and the use of a fat graft ( = 61/30.1%), nasoseptal flap (155/76.4%), or perioperative lumbar drain placement ( = 8/3.94%).  Complete resection is associated with increased risk of CSF leak and LOS. Operative strategies including placement of fat graft, nasoseptal flap, or intraoperative lumbar drain placement may have limited value in reducing the risk of postoperative CSF leak.