The learning curve and outcomes of 1038 endoscopic endonasal transsphenoidal pituitary tumor surgeries - A single surgical team experience

Pituitary adenomas rank third among adult intracranial tumors, with an incidence of 3.9- 7.4 cases/per 100,000 annually. Transsphenoidal surgery has evolved to include endoscopic endonasal surgery (EEA) in many centers due to technological and surgical advancements over the past two decades. We aim to analyze a 12-year cohort of pituitary adenomas operated through EEA, highlighting the evolution of surgical techniques and outcomes.

A retrospective review of patients undergoing EEA was conducted. A team of an otolaryngologist and neurosurgeon performed surgeries. The cohort was divided into three groups: Phase 1 (P1, 2012-2015), Phase 2 (P2, 2016-2019), and Phase 3 (P3, 2020-2023). Patient demographics, clinical data, and outcomes were collected from electronic medical records and compared over time.

The mean age was 54.2 years, with 53.5% being female. The gross total resection rate was 75.6%, increasing from 62.3% in P1 to 76.3% in P3 (P = 0.003). The mean operative duration was 274.61 min, with no significant correlation to case number. Complication rates, excluding cerebrospinal fluid (CSF) leaks, were similar between the groups, with no statistically significant differences observed for complications such as visual deficit, cranial nerve palsy, and epistaxis. However, meningitis decreased significantly from 3.8% to 0.3% (P < 0.001). Intraoperative CSF leaks decreased from 65.1% to 55% (P = 0.003). The need for revision surgery was lower in P3 (8.5% vs. 5.4% vs. 2.1, P < 0.001). Length of hospitalization decreased from 5.3 days to 3.9 days (P < 0.001).

Our experience with EEA for pituitary adenomas shows significant improvements in surgical outcomes, reduced complications, and better postoperative management, underscoring the importance of experience, technical refinement, and a multidisciplinary approach.