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Updated: Oct 29, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Comparative effectiveness of endoscopic versus microscopic transsphenoidal surgery for patients with growth hormone
Nidan Qiao1, Ming Shen2, Wenqiang He3
1Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China; Medical Science in Clinical Investigation, Harvard Medical School, Boston, USA; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Pituitary Tumor Center, Shanghai, China.
Introduction:
Previous studies failed to show the benefit of endoscopic surgery over microscopic surgery in terms of early endocrine remission. This study was to investigate whether early endocrine outcomes in patients with GH-secreting pituitary adenoma underwent endoscopic transsphenoidal surgery would be better than those operated by microscopic surgery.
Methods:
An acromegaly database collected from 2010 to 2019 in a single institution was used to emulate a randomized trial. Adult patients operated by a transsphenoidal approach using either endoscope or microscope were included. The primary outcome was endocrine remission based on insulin-like growth factor-1 (IGF-1) at six-month follow-up after surgery. We used inverse probability weighting to construct a pseudo population from which the treatment effect was estimated.
Results:
In the original cohort, 1118 patients underwent transsphenoidal surgery (424 with an endoscopic approach and 694 with a microscopic approach). Patients treated with endoscopic surgery were more likely to be previously surgical treated and to have an invasive tumor than patients who underwent microscopic surgery. In the pseudo population, the proportion of endocrine remission was 54.9% in the endoscopic group and 42.0% in the microscopic group (odds ratio, 1.68; 95% CI, 1.27-2.23). This finding was consistent and robust across several sensitivity analyses.
Conclusions:
Among patients with growth hormone secreting pituitary adenoma who underwent transsphenoidal surgery, endoscopic surgery was associated with higher early endocrine remission than microscopic surgery.
