Assessing surgical outcomes in pituitary adenoma: A comparison of microscopic and endoscopic techniques

The advantages of endoscopic resection of pituitary adenomas over microscopic have been exhaustively documented in the literature, though controversy persists regarding the superiority of either technique. The microscopic technique being more common at our center, we compared the outcome of patients operated by microscopic transsphenoidal surgery (MTS) and endoscopic transsphenoidal surgery (ETS) approach.

Retrospective data on transsphenoidal surgery for nonfunctional adenomas between 2019 and 2023 were analyzed. The symptoms, resection rates, surgical time, blood loss, and postoperative complications were compared with 1-year follow-up. The Statistical Package for the Social Sciences version 25 was used for statistical analysis.

We identified 91 patients who met the inclusion criteria. The MTS group included 48 (52.75%) patients, while the ETS category comprised 43 (47.25%). Headache was present in 47.91% of MTS and 72.09% of ETS cases (P = 0.0001). Other clinical symptoms were uniformly distributed in both groups. The operative time and blood loss were significantly lower in MTS (254.22 ± 37.65 vs. 289.53 ± 23.98) with p values of 0.0164 and 0.0001, respectively. Gross-total resection was achieved in 70.83% and 81.39% of patients in the MTS and ETS groups, respectively. No significant difference was observed in clinical and endocrinological outcomes, tumor recurrences, and complications until 1-year follow-up, except for sinusitis, which was higher in the ETS category (P = 0.05).

Both surgical techniques are well established for pituitary adenoma resection and are comparable in terms of complications. The surgeon's experience plays a critical role in pituitary surgery and its outcomes. However, tumor characteristics and patient-specific factors are also important determinants of the approach.