Surgical Outcome of Endoscopic Endonasal versus Microsurgical Transsphenoidal Approach for Pituitary Adenomas: An Institutional Experience

Objective: The aim of this study was to compare the efficacy of endoscopic versus microscopic resection of pituitary adenomas, and to evaluate the surgical possibilities of each approach.

Methods: Retrospective data were collected on patients who were operated for a pituitary lesion in our department between 2008 and 2018. Age, sex, presenting symptoms, length of stay (LOS), surgical approach, duration of surgery, tumor pathological features, grade of tumor resection (GTR), recurrence rate, and intraoperative and postoperative complications were noted. All procedures were performed by the same senior neurosurgeons.

Results: A total of 247 patients with pituitary adenoma were operated. One hundred seventeen patients were operated by endonasal endoscopic approach (EEA) and 130 patients were operated by microscopic transsphenoidal approach. Age and gender distribution did not differ between groups. The mean age was 52.3 ± 11.64 years (range: 21–72 years). The number of men was 150 (60.7%) and the number of women was 97 (39.3%). Nonfunctioning pituitary adenoma had 163 (66%) patients and 84 (34%) patients had a functioning pituitary adenoma. Among functioning pituitary adenoma, 60 (71.4%) patients had acromegaly and 24 (28.6%) patients had Cushing’s syndrome. Mean follow-up was 51 months (range: 5–112). In an endoscopic group (EG), complete tumor excision was achieved in 83 (70.9%) patients, and in microscopic group (MG), it was achieved in 72 (55.4%) patients. Postoperative sinusitis was present in 1 (0.85%) patient in EG and in 2 (1.54%) patients in MG. In our material we have no vascular complication in both groups. Slightly higher percentage of cerebrospinal fluid (CSF) leak (6.9 vs. 3.4%) was observed in MG as compared with EG. Postoperative anterior pituitary dysfunction rate in formerly intact patients was higher in the MG (11.5 vs. 6.8%). However, there was no significant difference between the groups regarding the rate of permanent diabetic insipidus. For the long-term outcomes, the rate of visual improvement was significantly higher in the EG than that in MG (77 vs. 50%, p < 0.001).

Conclusion: EEA for pituitary adenomas is a safe and effective procedure. It had minimal invasiveness; wider and direct control of the operative fields allows a greater and safer potential of tumor resection with respect to the critical neurovascular structures.