Transsphenoidal approach, indicated in most pituitary adenoma surgical interventions as well as in some other lesions, is considered safe. Nevertheless, complications may arise and can range from less serious to potentially hazardous. Our retrospective study evaluates patients who underwent such surgery during 29 years (1974–2002) and compares the results from the whole group (470 patients) to a subgroup from the last 10 years (220 patients). Comparison of the incidence of less important complications shows that they remain roughly constant, although slightly higher (new hormonal deficit 7.0 vs. 7.9%, diabetes insipidus 2.8–2.8%, peroperative 23.3–24.8% and postoperative 4.5–4.8% rhinorrhea). The number of most severe complications – death (4), meningitis, visual impairment and all states requiring surgical revision – decreased (4.5–2.8%). Mortality decreased from 0.85 to 0.48%. In the case of injury to internal carotid artery aneurysm, we used balloon occlusion as early as 1982. A total of 129 interventions (28.2%) had no complications. Complications can be prevented through maintaining constant orientation in the operative field. Less serious events, including liquorrhea, can be solved conservatively (tissue glue,lumbar drainage), vascular injury has to be recognized early and adequately treated.

        Key words: transsphenoidal approach, postoperative complications, iatrogenic vascular injury, pituitary adenoma