Comparison of peri-operative course of patients undergoing trans-sphenoidal pituitary surgery via endoscopic versus microscopic approach - A retrospective analysis

Background: Endonasal endoscopic approach for transsphenoidal excision of pituitary adenoma has undergone remarkable evolution in last two decades. It is considered less invasive and less stressful, with results comparable to the previous ‘gold standard’ technique of microscopic transsphenoidal excision of pituitary adenoma. Materials and Methods: Data of 307 patients from January 2011 till December 2013 were reviewed. Various parameters were divided and compared on the basis of type of approach for pituitary tumor resection vis-à-vis microscope assisted sublabialtranssphenoidal resection (MSLTS) or microscope assisted transnasal transsphenoidal resection (MTNTS) or endoscope assisted endonasal transsphenoidal resection (ETSS). Results: Demographic variables (except age); tumor type (microadenoma/macroadenoma/giant and functional status), dimensions, and invasiveness; patients’ comorbidities were comparable among three groups. Duration of surgery and anaesthesia were shortest for MTNTS group and longest for ETSS group (P < 0.001). Blood loss was higher in ETSS technique (median 300 ml) and least in MTNTS (median 100 ml) and difference was significant across all three groups (P = 0.0003). Postoperatively, pain, nausea/vomiting, electrolyte imbalance, respiratory and cardiovascular problems, and imaging findings were comparable among all the three groups. Post-operative CSF rhinorrhoea was 17% in the MSLTS group compared to 6.5% in MTNTS and 7.9% in ETSS (P = 0.047). Conclusions: ETSS with the expected advantage of being less invasive, offers a better chance for complete resection of adenoma. Neuroanaesthesiologist must however be prepared for longer surgical time and more blood loss as compared to previous microscopic approach, atleast till the surgeons expertise in this newer technique.

No conflict of interest has been declared by the author(s).

[Abstracts published in the Journal of Neuroanaesthesiology and Critical Care have not been reviewed by the Editorial Board of the Journal. These abstracts were presented at the annual meet of ISNACC and selected by the organizers and the scientific committee of the Society]