Volume 30, Issue 175, September 2026

The Most Common Complications Associated with Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Tumors: A Review

Justyna Kowalczewska^♦

Department of Neurosurgery, University Clinical Hospital in Poznan, Poznan University of Medical Sciences, Poznan, Poland

^♦Corresponding author
Justyna Kowalczewska, Department of Neurosurgery, University Clinical Hospital in Poznan, Poznan University of Medical Sciences, Poznan, Poland

ABSTRACT

Endoscopic endonasal transsphenoidal surgery (EETS) is currently the preferred surgical technique for the treatment of most pituitary tumours. Its advantages include wide, panoramic access to the sella turcica and perisellar structures. It simultaneously reduces the need for brain tissue retraction. When performed at experienced multidisciplinary centres, EETS is associated with a favourable safety profile. However, EETS can lead to complications affecting the endocrine system, fluid and electrolyte balance, the skull base, the nasal cavity, the optic chiasm, other cranial nerves and the great vessels. The most observed complications include transient vasopressin deficiency, delayed hyponatremia, the development of new anterior pituitary dysfunction, and postoperative cerebrospinal fluid leakage. Less common complications, such as internal carotid artery injury, postoperative hematoma, decreased visual acuity or visual field deficits, meningitis, or cerebral vasospasm, can lead to significant mortality and morbidity. The incidence of specific complications varies between studies. Risk reduction requires individualised patient assessment, precise surgical management, and standardised postoperative monitoring. Prompt detection of polyuria, sodium abnormalities, adrenal insufficiency, nasal cerebrospinal fluid leakage, visual disturbances, neurological deterioration, and epistaxis is particularly important. This review presents the mechanisms of development, clinical manifestations, preventive methods, and treatment options for complications associated with EETS.

Keywords: pituitary tumor; endoscopic endonasal surgery; transsphenoidal surgery; complications

Medical Science, 2026, 30, e182ms3966

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DOI: https://doi.org/10.54905/disssi.v30i175.e182ms3966

Published: 03 September 2026