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

This study aimed to evaluate the outcomes, histopathology and recurrence of pituitary neuroendocrine tumours following Endoscopic Endonasal Transsphenoidal Surgery (EETS) in a single institution, over a period of ten years.

A retrospective, cross-sectional study evaluated our experience and outcomes of EETS in 152 patients between 2013 and 2024. We analysed patient demographics and histopathology, as well as surgical complications. Outcomes such as tumour recurrence and improvement of visual field defects were recorded.

There were 64 males (42.1%) and 88 female patients (57.9%). Presentations included visual field disturbance, incidentaloma, acromegaly, headaches and Cushing's disease. 133 (87.5%) were macroadenomas and 14 (9.2%) microadenomas. Cavernous sinus invasion was observed in 35 patients (23.0%). Histologically, 72 (47.4%) gonadotroph tumours, 25 (16.4%) somatotroph tumours, 12 (7.9%) non-staining PitNETs/Null cell tumours, 12 (7.9%) corticotroph tumours, 11 (7.2%) plurihormonal tumours, 4 (2.6%) silent corticotroph tumours, 3 (2.0%) cysts, 1 (0.7%) prolactinoma, 1 (0.7%) thyrotroph tumour, and 11 (7.2%) were miscellaneous. Recurrence occurred in 29 (19.1%) patients, out of which 18 (11.8%) required further surgery. 51 (33.6%) patients experienced complications, such as cerebrospinal fluid (CSF) leak in 15 (9.9%) patients. A greater proportion of patients demonstrated normal visual fields postoperatively. Postoperative complications were similar to those reported in literature. Of note, recurrent tumours tended to have a low Ki-67 index of 0-3%.

Our findings are in line with those reported in literature, including histopathology of tumour subtypes and surgical complication rates. Visual field defects significantly improved following EETS. We note that predictors of postoperative recurrence cannot rely on the Ki-67 index alone; radiological, biochemical, and other histopathological markers need to be considered.