{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T06:43:33Z","timestamp":1792651413644,"version":"4.5.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T00:00:00Z","timestamp":1742342400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T00:00:00Z","timestamp":1742342400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Umea University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>The aim of this study was to explore risk factors for intraoperative events and postoperative complications of endoscopic transsphenoidal surgery (ETS) for pituitary tumors, and the role of intrasellar pressure (ISP) in relation to complications.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>The study was a single-center, retrospective, consecutive, observational study, with ISP data collected prospectively. After exclusions, the study population encompassed 69 patients. All had ISP measured intraoperatively during ETS for a pituitary adenoma and underwent standardized postoperative observations and follow-up. Data on complications within 3\u00a0months after surgery and some risk factors were collected retrospectively.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Decreased risk of postoperative cerebrospinal fluid leakage was seen with higher age. Large tumor volume was associated with higher risk of intraoperative events. ISP was not associated with complication frequency, but patients with ISP\u2009&gt;\u200920\u00a0mmHg had increased frequency of postoperative epistaxis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>This study confirms earlier findings of low age as a possible risk factor for postoperative cerebrospinal fluid leakage. Tumor volume is suggested to be associated with higher complication risk. ISP does not seem to be a significant risk factor for intraoperative events or postoperative complications following ETS. Predictive risk factors for surgical complications after ETS are still not satisfactorily explained and heterogeneous definitions of complications are problematic in this context.\n<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00701-025-06495-7","type":"journal-article","created":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T19:15:13Z","timestamp":1742411713000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Complications following endoscopic transsphenoidal surgery for pituitary adenoma\u2014special focus on intrasellar pressure"],"prefix":"10.1007","volume":"167","author":[{"given":"Gabriel","family":"Simander","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per Olof","family":"Eriksson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Viirola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Lindvall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars-Owe D.","family":"Koskinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,19]]},"reference":[{"key":"6495_CR1","doi-asserted-by":"publisher","first-page":"1789","DOI":"10.1210\/jc.85.5.1789","volume":"85","author":"BM Arafah","year":"2000","unstructured":"Arafah BM, Prunty D, Ybarra J, Hlavin ML, Selman WR (2000) The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas. J Clin Endocrinol Metab 85:1789\u20131793. https:\/\/doi.org\/10.1210\/jc.85.5.1789","journal-title":"J Clin Endocrinol Metab"},{"key":"6495_CR2","doi-asserted-by":"publisher","first-page":"807040","DOI":"10.3389\/fonc.2021.807040","volume":"11","author":"M Araujo-Castro","year":"2021","unstructured":"Araujo-Castro M, Acitores Cancela A, Vior C, Pascual-Corrales E, Rodr\u00edguez Berrocal V (2021) Radiological Knosp, Revised-Knosp, and Hardy-Wilson classifications for the prediction of surgical outcomes in the endoscopic endonasal surgery of pituitary adenomas: study of 228 cases. Front Oncol 11:807040. https:\/\/doi.org\/10.3389\/fonc.2021.807040","journal-title":"Front Oncol"},{"key":"6495_CR3","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1007\/s00701-022-05456-8","volume":"165","author":"OF Bengtsson","year":"2023","unstructured":"Bengtsson OF, Sunnergren O, Segerhammar I, Forander P, Olsson M, Hulting AL, Stjarne P (2023) Remission, complications, and overall survival in transsphenoidal pituitary surgery-a Swedish single-center experience of 578 patients. Acta Neurochir (Wien) 165:685\u2013692. https:\/\/doi.org\/10.1007\/s00701-022-05456-8","journal-title":"Acta Neurochir (Wien)"},{"key":"6495_CR4","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1007\/s11102-011-0368-2","volume":"15","author":"M Berker","year":"2012","unstructured":"Berker M, Hazer DB, Yucel T, Gurlek A, Cila A, Aldur M, Onerci M (2012) Complications of endoscopic surgery of the pituitary adenomas: analysis of 570 patients and review of the literature. Pituitary 15:288\u2013300. https:\/\/doi.org\/10.1007\/s11102-011-0368-2","journal-title":"Pituitary"},{"key":"6495_CR5","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1002\/alr.21622","volume":"6","author":"CC Boling","year":"2016","unstructured":"Boling CC, Karnezis TT, Baker AB, Lawrence LA, Soler ZM, Vandergrift WA 3rd, Wise SK, DelGaudio JM, Patel ZM, Rereddy SK, Lee JM, Khan MN, Govindaraj S, Chan C, Oue S, Psaltis AJ, Wormald PJ, Trosman S, Stokken J, Woodard T, Sindwani R, Schlosser RJ (2016) Multi-institutional study of risk factors for perioperative morbidity following transnasal endoscopic pituitary adenoma surgery. Int Forum Allergy Rhinol 6:101\u2013107. https:\/\/doi.org\/10.1002\/alr.21622","journal-title":"Int Forum Allergy Rhinol"},{"key":"6495_CR6","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1007\/s11102-008-0087-5","volume":"11","author":"P Cappabianca","year":"2008","unstructured":"Cappabianca P, Cavallo LM, de Divitiis O, Solari D, Esposito F, Colao A (2008) Endoscopic pituitary surgery. Pituitary 11:385\u2013390. https:\/\/doi.org\/10.1007\/s11102-008-0087-5","journal-title":"Pituitary"},{"key":"6495_CR7","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.3171\/2012.2.JNS111837","volume":"116","author":"BJ Dlouhy","year":"2012","unstructured":"Dlouhy BJ, Madhavan K, Clinger JD, Reddy A, Dawson JD, O\u2019Brien EK, Chang E, Graham SM, Greenlee JD (2012) Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery. J Neurosurg 116:1311\u20131317. https:\/\/doi.org\/10.3171\/2012.2.JNS111837","journal-title":"J Neurosurg"},{"key":"6495_CR8","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1080\/02841859709171238","volume":"38","author":"AL Edal","year":"1997","unstructured":"Edal AL, Skjodt K, Nepper-Rasmussen HJ (1997) SIPAP\u2013a new MR classification for pituitary adenomas. Suprasellar, infrasellar, parasellar, anterior and posterior. Acta Radiol 38:30\u201336","journal-title":"Acta Radiol"},{"key":"6495_CR9","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1093\/neuros\/nyy087","volume":"84","author":"Y Hayashi","year":"2019","unstructured":"Hayashi Y, Sasagawa Y, Oishi M, Kita D, Misaki K, Fukui I, Tachibana O, Nakada M (2019) Contribution of intrasellar pressure elevation to headache manifestation in pituitary adenoma evaluated with intraoperative pressure measurement. Neurosurgery 84:599\u2013606. https:\/\/doi.org\/10.1093\/neuros\/nyy087","journal-title":"Neurosurgery"},{"key":"6495_CR10","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/j.wneu.2016.09.051","volume":"96","author":"JH Jang","year":"2016","unstructured":"Jang JH, Kim KH, Lee YM, Kim JS, Kim YZ (2016) Surgical results of pure endoscopic endonasal transsphenoidal surgery for 331 pituitary adenomas: a 15-year experience from a single institution. World Neurosurg 96:545\u2013555. https:\/\/doi.org\/10.1016\/j.wneu.2016.09.051","journal-title":"World Neurosurg"},{"key":"6495_CR11","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1002\/alr.21783","volume":"6","author":"TT Karnezis","year":"2016","unstructured":"Karnezis TT, Baker AB, Soler ZM, Wise SK, Rereddy SK, Patel ZM, Oyesiku NM, DelGaudio JM, Hadjipanayis CG, Woodworth BA, Riley KO, Lee J, Cusimano MD, Govindaraj S, Psaltis A, Wormald PJ, Santoreneos S, Sindwani R, Trosman S, Stokken JK, Woodard TD, Recinos PF, Vandergrift WA 3rd, Schlosser RJ (2016) Factors impacting cerebrospinal fluid leak rates in endoscopic sellar surgery. Int Forum Allergy Rhinol 6:1117\u20131125. https:\/\/doi.org\/10.1002\/alr.21783","journal-title":"Int Forum Allergy Rhinol"},{"key":"6495_CR12","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1227\/00006123-199310000-00008","volume":"33","author":"E Knosp","year":"1993","unstructured":"Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary adenomas with invasion of the cavernous sinus space: A magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33:610\u2013618. https:\/\/doi.org\/10.1227\/00006123-199310000-00008","journal-title":"Neurosurgery"},{"key":"6495_CR13","doi-asserted-by":"publisher","first-page":"2141","DOI":"10.1007\/s00701-013-1856-0","volume":"155","author":"LOD Koskinen","year":"2013","unstructured":"Koskinen LOD, Grayson D, Olivecrona M (2013) The complications and the position of the codman MicroSensor\u2122 ICP device: an analysis of 549 patients and 650 sensors. Acta Neurochir 155:2141\u20132148. https:\/\/doi.org\/10.1007\/s00701-013-1856-0","journal-title":"Acta Neurochir"},{"key":"6495_CR14","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1227\/01.neu.0000156609.95596.24","volume":"56","author":"LOD Koskinen","year":"2005","unstructured":"Koskinen LOD, Olivecrona M (2005) Clinical experience with the intraparenchymal intracranial pressure monitoring Codman microsensor system. Neurosurgery 56:693\u2013697. https:\/\/doi.org\/10.1227\/01.neu.0000156609.95596.24","journal-title":"Neurosurgery"},{"key":"6495_CR15","doi-asserted-by":"publisher","first-page":"E221","DOI":"10.1227\/01.neu.0000371142.74277.b9","volume":"67","author":"LOD Koskinen","year":"2010","unstructured":"Koskinen LOD, Olivecrona M (2010) Intracranial pressure monitoring using the codman microSensor. Neurosurgery 67:E221. https:\/\/doi.org\/10.1227\/01.neu.0000371142.74277.b9","journal-title":"Neurosurgery"},{"key":"6495_CR16","doi-asserted-by":"publisher","first-page":"313","DOI":"10.3109\/02688699409029619","volume":"8","author":"PD Lees","year":"1994","unstructured":"Lees PD, Fahlbusch R, Zrinzo A, Pickard JD (1994) Intrasellar pituitary tissue pressure, tumour size and endocrine status\u2013an international comparison in 107 patients. Brit J Neurosurg 8:313\u2013318. https:\/\/doi.org\/10.3109\/02688699409029619","journal-title":"Brit J Neurosurg"},{"key":"6495_CR17","doi-asserted-by":"publisher","first-page":"192","DOI":"10.3171\/jns.1987.67.2.0192","volume":"67","author":"PD Lees","year":"1987","unstructured":"Lees PD, Pickard JD (1987) Hyperprolactinemia, intrasellar pituitary tissue pressure, and the pituitary stalk compression syndrome. J Neurosurg 67:192\u2013196. https:\/\/doi.org\/10.3171\/jns.1987.67.2.0192","journal-title":"J Neurosurg"},{"key":"6495_CR18","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1007\/s11102-017-0839-1","volume":"21","author":"DJ Lobatto","year":"2018","unstructured":"Lobatto DJ, Vries Fd, Najafabadi AHZ, Pereira AM, Peul WC, Vlieland TPMV, Biermasz NR, Furth WRv (2018) Preoperative risk factors for postoperative complications in endoscopic pituitary surgery: a systematic review. Pituitary 21:84\u201397. https:\/\/doi.org\/10.1007\/s11102-017-0839-1","journal-title":"Pituitary"},{"key":"6495_CR19","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1016\/j.wneu.2016.02.059","volume":"89","author":"E Magro","year":"2016","unstructured":"Magro E, Graillon T, Lassave J, Castinetti F, Boissonneau S, Tabouret E, Fuentes S, Velly L, Gras R, Dufour H (2016) Complications related to the endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary macroadenomas in 300 consecutive patients. World Neurosurg 89:442\u2013453. https:\/\/doi.org\/10.1016\/j.wneu.2016.02.059","journal-title":"World Neurosurg"},{"key":"6495_CR20","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1056\/NEJMra1810772","volume":"382","author":"S Melmed","year":"2020","unstructured":"Melmed S (2020) Pituitary-tumor endocrinopathies. N Engl J Med 382:937\u2013950. https:\/\/doi.org\/10.1056\/NEJMra1810772","journal-title":"N Engl J Med"},{"key":"6495_CR21","doi-asserted-by":"publisher","first-page":"503","DOI":"10.3171\/jns.1977.47.4.0503","volume":"47","author":"JD Miller","year":"1977","unstructured":"Miller JD, Becker DP, Ward JD, Sullivan HG, Adams WE, Rosner MJ (1977) Significance of intracranial hypertension in severe head injury. J Neurosurg 47:503\u2013516. https:\/\/doi.org\/10.3171\/jns.1977.47.4.0503","journal-title":"J Neurosurg"},{"key":"6495_CR22","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1177\/0194599817721445","volume":"157","author":"HJ Min","year":"2017","unstructured":"Min HJ, Kang H, Choi GJ, Kim KS (2017) Association between hypertension and epistaxis: systematic review and meta-analysis. Otolaryngol Head Neck Surg 157:921\u2013927. https:\/\/doi.org\/10.1177\/0194599817721445","journal-title":"Otolaryngol Head Neck Surg"},{"key":"6495_CR23","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1001\/jama.2016.19699","volume":"317","author":"ME Molitch","year":"2017","unstructured":"Molitch ME (2017) Diagnosis and treatment of pituitary adenomas: a review. JAMA 317:516\u2013524. https:\/\/doi.org\/10.1001\/jama.2016.19699","journal-title":"JAMA"},{"key":"6495_CR24","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/s12883-022-02601-9","volume":"22","author":"G Simander","year":"2022","unstructured":"Simander G, Eriksson PO, Lindvall P, Koskinen LD (2022) Intrasellar pressure in patients with pituitary adenoma - relation to tumour size and growth pattern. BMC Neurol 22:82. https:\/\/doi.org\/10.1186\/s12883-022-02601-9","journal-title":"BMC Neurol"},{"key":"6495_CR25","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2023.03.085","author":"G Simander","year":"2023","unstructured":"Simander G, Dahlqvist P, Oja L, Eriksson PO, Lindvall P, Koskinen LD (2023) Intrasellar pressure is related to endocrine disturbances in patients with pituitary tumors. World Neurosurg. https:\/\/doi.org\/10.1016\/j.wneu.2023.03.085","journal-title":"World Neurosurg"}],"container-title":["Acta Neurochirurgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06495-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00701-025-06495-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06495-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T19:15:18Z","timestamp":1742411718000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00701-025-06495-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,19]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6495"],"URL":"https:\/\/doi.org\/10.1007\/s00701-025-06495-7","relation":{},"ISSN":["0942-0940"],"issn-type":[{"value":"0942-0940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,19]]},"assertion":[{"value":"5 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 March 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Regional Ethics Review Board, Department of Medical Research, Ume\u00e5, Sweden, 2018\/227\u201331. The surgical procedure that all subjects have undergone was the routine surgical treatment option at the clinic, before which conventional informed verbal consent was obtained. For this retrospective study, including data collection and analysis, no further consent was needed. This was approved by the Ethics Review Board. The study was conducted in accordance with the World Medical Association Declaration of Helsinki, Ethical Principles for Medical Research Involving Human Subjects.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The manuscript does not contain any individual person\u2019s data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"83"}}