Outcome Analysis of Microscopic versus Endoscopic Pituitary Surgery for Resection of Pituitary Adenomas

Introduction & With the introduction of endoscope in the field of neurosurgery since 1980, the approaches to the sellar region has been modified remarkably, and Endoscopic Transsphenoidal surgery for pituitary tumors is now a good alternative to the traditional Microscopic Transseptal approach with comparable results. All patients who were operated for pituitary adenoma using either endoscopic or microscopic transsphenoidal approaches from 2008 until 2012, were followed up on a regular basis by neuroimaging, pituitary hormonal study and neuro-ophtalmologic examination. Short-term and long-term complications, the rate of hormonal remission, visual improvement in long-term, and recurrence rate were compared between the two groups. Forty one patients were included in this study. Thirty two cases were operated upon using the endoscopic approach, and 9 were operated upon by the microscopic approach. Null cell adenoma was the most common pituitary tumor in the series. The rate of short-term and long-term complications including DI, CSF leak, and sinusitis, were more common in the group who underwent endoscopic resection of pituitary adenoma, although this approach was associated with lower recurrence rate, less hospital stay, and more success in the rate of hormonal normalization (P > 0.005 for all variables). The present study suggests that endoscopic approaches to the sellar region can be done safely with comparable results with microscopic approaches in the experienced and well equipped hands, although prospective randomized studies are needed to address better results.