*9.1.4 Complications*

Transsphenoidal approach is usually safe and associated with low morbidity rate [73]. The most feared intraoperative complication is ICA injury, which has a very low incidence rate. However, it is associated with significant morbidity and mortality. Consequences of a such injury include pseudoaneurysm formation and carotid cavernous fistula.

Postoperative complications include the ones related to the nose (nasal septum perforation, insomnia, epistaxis from injury to sphenopalatine artery or its branches), sphenoid sinus complications (mucocele formation, sinusitis or sphenoid bone fractures), or related to intrasellar (hemorrhage, cerebrospinal fluid (CSF) leak and tension pneumocephalus).

CSF leak incidence has decreased in recent years due to the advancements and newer techniques in harvesting vascularized nasoseptal flaps [74]. CSF leak incidence in recently published series falls between 1% and 4% [75].
