Proposed algorithm for early postoperative evaluation after endonasal endoscopic resection of pituitary adenomas with suprasellar extension.

Background: Pituitary adenomas account for 10-15% of intracranial tumors and are commonly treated with endoscopic transsphenoidal surgery. However, postoperative care protocols and the management of complications, especially in limited-resource settings, remain poorly standardized. This study evaluates the effectiveness of a postoperative monitoring protocol implemented in the intermediate postoperative care unit (IPCU) for early complication detection and management. Methods: This retrospective case series includes 77 patients who underwent endoscopic pituitary adenoma resection between March 2021 and February 2023. A postoperative monitoring algorithm focused on the early identification and management of complications was implemented in the IPCU. Descriptive and inferential statistical methods were employed to analyze the data. Results: Among the patients, 5.2% developed vasospasm, and 2.6% experienced hydrocephalus. Patients with suprasellar extension had significantly longer IPCU stays compared to those with sellar-only tumors. The modified Rankin scale was found to be significantly associated with the occurrence of postoperative vasospasm. While no significant associations were observed between tumor characteristics and complications, trends were noted regarding clinical outcomes such as total hospital stay and discharge Rankin score. Conclusion: The standardized postoperative care protocol in the IPCU effectively identified and managed early complications, including vasospasm, following endoscopic pituitary adenoma surgery. Further research, particularly multicenter studies, is necessary to validate these findings and establish standardized care protocols across healthcare institutions.