Comparison of endoscopic and endoscope-assisted microscopic transsphenoidal surgery for pituitary adenoma resection: a prospective randomized study

Abstract

Objective: The value of endoscopic versus microsurgical approach has not yet been defined in transsphenoidal pituitary adenoma surgery. In this study, we compare both methods and analyze the long-term surgical, radiological, endocrinological, ophthalmological, and rhinological results as well as the patients' quality of life.

Methods: A total of 33 individuals with elective transsphenoidal pituitary adenoma surgery were randomized (pure endoscopic approach or endoscope-assisted microscopic approach) and prospectively underwent investigations with a focus on patient-related subjective outcome measurements.

Results: The mean follow-up period was 6.3 years. In the microsurgical group, endoscopic inspection revealed residual tumor in seven of 15 patients (46.7%) not seen by the microscope. Endoscopic resection provided long-term tumor-free state in all of them. Compared to pure microsurgical treatment, endoscopy was associated with a lower probability of tumor recurrence (OR = 0.24) and appeared advantageous in the long-term achievement of any surgical goal (OR = 3.80) as well as in anterior pituitary lobe function improvement (OR = 1.60). Where gross total tumor resection was the stated preoperative goal, there was no long-term tumor recurrence in 81.8% (endoscopy group) and 83.3% (endoscope-assisted microsurgical group). Most aspects showed no significant difference between the techniques, such as length of hospital stay, complication rate (endoscopy: 16.7%, endoscope-assisted microsurgery: 20.0%), long-term maintenance of any preoperatively stated extent of resection, pituitary and olfactory function, rates of DI and SIADH, ophthalmological improvement, and SNOT scores.

Conclusions: Both techniques provide good long-term surgical, radiological, endocrinological, rhinological, and ophthalmological results. Endoscopy clearly improved the rate of long-term achievement of the initial surgical goal and the anterior pituitary lobe function.

Keywords: endonasal; endoscopic transnasal approach; pituitary; pituitary adenoma; transsphenoidal surgery.

Figure 1

Anterior pituitary lobe function over time. The diagram depicts the non-continuous development of anterior pituitary lobe function over time.

Figure 2

Achievement of overall well-being over time. The diagram depicts the non-continuous time point when symptom-free well-being was achieved. The values are in %.

Figure 3

Achievement of rhinological well-being over time. The diagram depicts the non-continuous time point when symptom-free well-being was achieved. The values are in %.

Figure 4

Mental and physical scores of SF-36 over time. E, endoscopic group; M, microsurgical group; MCS, mental component summary score; PCS, physical component summary score; continuous line, normal value of German population. Higher scores indicate a higher quality of life. Significant (red dots) and non-significant (black dots) results compared to the normal value are distinguished. We compared our data to the healthy German population (46) (straight line).