Alzhrani Gmaan, Sivakumar Walavan, Park Min S, Taussky Philipp, Couldwell William T
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
World Neurosurg. 2018 Jan;109:233-241. doi: 10.1016/j.wneu.2017.09.192. Epub 2017 Oct 5.
Perioperative complications after transsphenoidal surgery for pituitary adenomas have been well documented in the literature; however, some complications can occur in a delayed fashion postoperatively, and reports are sparse about their occurrence, management, and outcome. Here, we describe delayed complications after transsphenoidal surgery and discuss the incidence, temporality from the surgery, and management of these complications based on the findings of studies that reported delayed postoperative epistaxis, delayed postoperative cavernous carotid pseudoaneurysm formation and rupture, vasospasm, delayed symptomatic hyponatremia, hypopituitarism, hydrocephalus, and sinonasal complications. Our findings from this review revealed an incidence of 0.6%-3.3% for delayed postoperative epistaxis at 1-3 weeks postoperatively, 18 reported cases of delayed carotid artery pseudoaneurysm formation at 2 days to 10 years postoperatively, 30 reported cases of postoperative vasospasm occurring 8 days postoperatively, a 3.6%-19.8% rate of delayed symptomatic hyponatremia at 4-7 days postoperatively, a 3.1% rate of new-onset hypopituitarism at 2 months postoperatively, and a 0.4%-5.8% rate of hydrocephalus within 2.2 months postoperatively. Sinonasal complications are commonly reported after transsphenoidal surgery, but spontaneous resolutions within 3-12 months have been reported. Although the incidence of some of these complications is low, providing preoperative counseling to patients with pituitary tumors regarding these delayed complications and proper postoperative follow-up planning is an important part of treatment planning.
垂体腺瘤经蝶窦手术围手术期并发症在文献中已有充分记载；然而，一些并发症可能在术后延迟出现，关于其发生、处理及结局的报道较少。在此，我们描述经蝶窦手术后的延迟并发症，并根据报道术后延迟鼻出血、延迟性海绵窦颈内动脉假性动脉瘤形成及破裂、血管痉挛、延迟性症状性低钠血症、垂体功能减退、脑积水和鼻旁窦并发症的研究结果，讨论这些并发症的发生率、与手术的时间关系及处理。我们本次综述的结果显示，术后1 - 3周延迟鼻出血的发生率为0.6% - 3.3%，术后2天至10年有18例延迟性颈动脉假性动脉瘤形成的报道，术后8天有30例术后血管痉挛的报道，术后4 - 7天延迟性症状性低钠血症的发生率为3.6% - 19.8%，术后2个月新发垂体功能减退的发生率为3.1%，术后2.2个月内脑积水的发生率为0.4% - 5.8%。经蝶窦手术后鼻旁窦并发症常见，但也有报道称在3 - 12个月内可自行缓解。尽管其中一些并发症的发生率较低，但向垂体肿瘤患者提供关于这些延迟并发症的术前咨询以及适当的术后随访计划是治疗计划的重要组成部分。
