Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery in a single center

Abstract

Pituitary Adenomas (PA) are a group of benign tumors with diverse biological behavior including different hormonal secretion, cavernous sinus invasion and considerable rates of relapse. The aim of the study was to evaluate the benefits of the Endoscopic Endonasal Transsphenoidal (EET) approach for managing hormonal producing Pituitary Adenomas (PA) in terms of achieving clinical remission in comparison to the Microscopic Endonasal Transsphenoidal (MET) approach. During the period 2014 to 2017 a series of 128 patients with PA were operated on via MET (n=62) and EET (n=66) approach. Endocrinological, neuro-ophthalmic and MRI examinations were assessed preoperatively and postoperatively at 3rd and 12th month. Thirty-two patients were diagnosed with growth-hormone secreting adenomas (GH), 25 with Adrenocorticotropic Hormone secreting adenomas (ACTH), 17 with Prolactin-secreting adenomas (Prl) and 54 with non-secreting pituitary adenomas. The endoscopic group had higher levels of remission in comparison to the microscopic group (81.8% vs. 70.9%), however no significant difference was observed (?=0.128). PA with invasiveness to the cavernous sinus from the endoscopic group had significantly better remission rates opposed to the microscopic group (p<0.05). Macroadenomas not exceeding 40 mm in diameter had higher remission rates in the endoscopic group (p<0.05). Examination of postoperatiove complications showed similar incidence of postoperative diabetes insipidus and CSF leak (p>0.05). The use of endoscopic endonasal transphenoidal approach provides better remission rates in invasive PA compared to the conventional microsurgical approach. A long-term follow-up is still needed for further evaluation of our results.