Comparison of Microscopic and Endoscopic Transsphenoidal Surgery for Pituitary Adenomas

Abstract

Both microscopic and endoscopic transsphenoidal approaches can be utilized to treat pituitary adenomas or pituitary neuroendocrine tumors (PitNETs). While both techniques have shown comparable beneficial outcomes, challenges remain, and definitive long-term data are lacking. A comprehensive study could help optimize surgical strategies for pituitary tumor management, ultimately improving patient outcomes. This retrospective study compares the outcomes of microscopic and endoscopic transsphenoidal surgeries for treating pituitary tumors. Fifty-two patients (23 men and 29 women) who underwent surgery between January 2012 and December 2018 were included. Patients were classified into two groups based on the surgical approach: 26 underwent microscopic surgery and 26 underwent endoscopic surgery. Preoperative and postoperative MRI scans, tumor size, and hormone levels were analyzed. The primary outcomes evaluated included the extent of tumor resection, complication rates, hormonal remission, and improvements in visual symptoms. The results showed no statistically significant difference in tumor resection between the two groups, with total radiological remission achieved in 65.4% of patients in both the microscopic and endoscopic groups. The hormonal remission rate was 81.3% in the microscopic group and 86.6% in the endoscopic group. Complications included transient diabetes insipidus in 25% of patients and rhinorrhea in 9.6%, and no surgical mortality was observed. The endoscopic approach offered advantages such as reduced mucosal trauma and improved visualization, while challenges included the need for a bloodless surgical field. Despite these differences, both techniques demonstrated comparable outcomes regarding tumor resection, complication rates, and hormonal remission.

Keywords: brain tumor; endonasal endoscopic transsphenoidal surgery; microscopic; nonfunctioning pituitary adenoma; pituitary adenoma; pituitary adenoma management; transsphenoidal resection.