Endoscopic Endonasal Transsphenoidal Surgery (EETS) for PitNETs: Outcomes in a Single Institution Over a Decade

Area of Science:

• Neurosurgery
• Endocrinology
• Oncology

Background:

• Pituitary neuroendocrine tumors (PitNETs) are complex neoplasms requiring effective surgical management.
• Endoscopic Endonasal Transsphenoidal Surgery (EETS) has become a primary approach for resecting these tumors.
• Evaluating long-term outcomes, histopathology, and recurrence patterns is crucial for optimizing patient care.

Purpose of the Study:

• To assess the outcomes, histopathology, and recurrence rates of PitNETs treated with EETS over a decade.
• To analyze surgical complications and the effectiveness of EETS in improving patient symptoms, such as visual field defects.
• To identify potential predictors of tumor recurrence following surgical intervention.

Main Methods:

• A retrospective, cross-sectional study of 152 patients who underwent EETS between 2013 and 2024.
• Analysis of patient demographics, tumor histopathology, and surgical complications.
• Evaluation of outcomes including tumor recurrence and improvement in visual field defects.

Main Results:

• Macroadenomas (87.5%) were the predominant tumor type, with gonadotroph tumors being the most common subtype (47.4%).
• Recurrence occurred in 19.1% of patients, with 11.8% requiring re-operation; 33.6% experienced complications, including CSF leaks (9.9%).
• Significant improvement in visual fields was observed postoperatively, and recurrent tumors showed a low Ki-67 index (0-3%).

Conclusions:

• EETS is a safe and effective surgical modality for PitNETs, yielding outcomes consistent with existing literature.
• The surgery leads to significant improvement in visual field defects.
• The Ki-67 index alone is insufficient for predicting recurrence; a multimodal approach considering radiological, biochemical, and other histopathological markers is necessary.