{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:27:08Z","timestamp":1786728428190,"version":"build-2736575974"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>Third nerve palsy is a rare complication of transsphenoidal surgery and has been merely mentioned in different studies, but there is not any rigorous analysis focusing on this particular complication. The purpose of this study is to analyze this complication after transsphenoidal surgery for a pituitary adenoma to better understand its pathophysiology and outcome. The authors retrospectively analyzed 3 cases of third nerve palsy selected from the 377 patients operated via a transsphenoidal route between 2012 and 2021 at FLENI, a private tertiary neurology and neurosurgical medical center located in Buenos Aires, Argentina. The three patients who presented this complication were operated on via an endoscopic approach. It was observed that an extension into the cavernous sinus (Knosp grade 4) and to the oculomotor cistern was present in the three patients. The deficit was apparent immediately after surgery in two patients. For these two patients, the supposed mechanism of ophthalmoplegia was an intraoperative nerve lesion. The other patient became symptomatic in the 48 h following the surgery. The mechanism implied in this case was intracavernous hemorrhagic suffusion. The latter patient completely recovered the third nerve deficit in the 3 months that followed, while the other two recovered after 6 months postoperative. Oculomotor nerve palsy after transsphenoidal surgery is a very rare complication and appears to be transient in most cases. The invasion of both the cavernous sinus and the oculomotor cistern seems to be a major factor in its physiopathology and should be preoperatively analyzed on magnetic resonance imaging (MRI); recognizing such extension should play an important role in the surgeon's operative considerations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/0028-3886.378673","type":"journal-article","created":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T04:18:06Z","timestamp":1692850686000},"page":"522-526","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative Third Nerve Palsy after Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenoma"],"prefix":"10.4103","volume":"71","author":[{"given":"Facundo","family":"Villamil","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Caffaratti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro E","family":"Ruella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian J M","family":"Giovannini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andres","family":"Cervio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-21-20240907","first-page":"1","article-title":"Ophthalmoplegic complications in transsphenoidal pituitary surgery","volume":"26","author":"Florea","year":"2019","journal-title":"J Neurosurg"},{"key":"R2-21-20240907","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1016\/j.wneu.2016.02.059","article-title":"Complications related to the endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary macroadenomas in 300 consecutive patients","volume":"89","author":"Magro","year":"2016","journal-title":"World Neurosurg"},{"key":"R3-21-20240907","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1007\/s00464-014-3815-0","article-title":"Endoscopic endonasal transsphenoidal surgery of 1,166 pituitary adenomas","volume":"29","author":"Wang","year":"2015","journal-title":"Surg Endosc"},{"key":"R4-21-20240907","doi-asserted-by":"crossref","first-page":"13","DOI":"10.3171\/jns.1978.48.1.0013","article-title":"Transsphenoidal microsurgical removal of 250 pituitary adenomas","volume":"48","author":"Wilson","year":"1978","journal-title":"J Neurosurg"},{"key":"R5-21-20240907","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1007\/s11102-021-01167-y","article-title":"Complication avoidance protocols in endoscopic pituitary adenoma surgery: A retrospective cohort study in 514 patients","volume":"24","author":"Thakur","year":"2021","journal-title":"Pituitary"},{"key":"R6-21-20240907","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1227\/01.NEU.0000159647.64275.9D","article-title":"Results of transsphenoidal surgery in a large series of patients with pituitary adenoma","volume":"56","author":"Mortini","year":"2005","journal-title":"Neurosurgery"},{"key":"R7-21-20240907","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1007\/s00701-007-1244-8","article-title":"Complications of transsphenoidal surgery in patients with pituitary adenoma: Experience at a single centre","volume":"149","author":"Barzaghi","year":"2007","journal-title":"Acta Neurochir (Wien"},{"key":"R8-21-20240907","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1007\/s00701-013-1959-7","article-title":"Surgical complications after transsphenoidal microscopic and endoscopic surgery for pituitary adenoma: A consecutive series of 506 procedures","volume":"156","author":"Halvorsen","year":"2014","journal-title":"Acta Neurochir (Wien"},{"key":"R9-21-20240907","doi-asserted-by":"crossref","first-page":"E12","DOI":"10.3171\/2014.10.FOCUS14705","article-title":"Complications after transsphenoidal surgery for patients with Cushing's disease and silent corticotroph adenomas","volume":"38","author":"Smith","year":"2015","journal-title":"Neurosurg Focus"},{"key":"R10-21-20240907","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3171\/jns.1999.91.2.0175","article-title":"Complications in a contemporary series of patients who underwent transsphenoidal surgery for Cushing's disease","volume":"91","author":"Semple PL, Laws","year":"1999","journal-title":"J Neurosurg"},{"key":"R11-21-20240907","doi-asserted-by":"crossref","first-page":"707","DOI":"10.3171\/jns.1979.51.5.0707","article-title":"False aneurysm of the cavernous carotid artery and progressive external ophthalmoplegia after transsphenoidal hypophysectomy. 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