Comparison of complete resection rate and endocrine function improvement between neuronavigation-assisted...

This study aimed to compare the complete resection rate and endocrine function improvement between the neuronavigation-assisted neuroendoscopic transnasal transsphenoidal approach and the microscopic transcranial approach for giant pituitary adenomas (diameter ≥4 cm). In a retrospective cohort of 300 patients, 132 underwent the transsphenoidal approach and 168 the transcranial approach. Postoperative magnetic resonance imaging revealed a significantly higher complete resection rate in the transsphenoidal group (71.21% vs. 59.52%, P=0.036). At two weeks postoperatively, the transsphenoidal group demonstrated significantly better outcomes in endocrine function, visual field parameters, and surgical indicators (shorter operation time, less blood loss, and shorter postoperative stay), with a lower overall complication rate (13.64% vs. 23.21%, P=0.036). Multivariate analysis identified the transsphenoidal approach as an independent protective factor against incomplete resection. In conclusion, for selected giant pituitary adenomas, the neuronavigation-assisted neuroendoscopic transnasal transsphenoidal approach may be superior to the microscopic transcranial approach in achieving higher rates of complete resection, better endocrine and visual recovery, and reduced surgical trauma.