Bilateral approach selection in neuroendoscopic surgery for pituitary adenomas and health economic evaluation

To investigate the impact of bilateral approach selection in neuroendoscopic transsphenoidal surgery for pituitary adenomas on patient prognosis and to analyze the medical burden on patients from a health economic perspective.

A retrospective analysis was conducted on the data of 197 patients who underwent pituitary adenoma surgery. The patients were divided into two groups based on the surgical approach: the transseptal approach group (n = 108) and the bilateral nostril expanded transsphenoidal approach group (n = 89). The medical burden, clinical efficacy, surgical indicators, hormone levels, and complications were compared between the two groups.

Compared with the bilateral nostril expanded transsphenoidal approach, the transseptal approach was associated with significantly less intraoperative blood loss and shorter operative time (P < 0.05). No significant differences were observed in total medical costs, psychological burden, hormone profiles, or complication rates. Postoperative nasal packing was associated with reduced rates of diabetes insipidus and thyroid-stimulating hormone abnormalities (P < 0.05) and a marginally significant reduction in cerebrospinal fluid rhinorrhea (P = 0.05).

The transseptal approach in pituitary adenoma surgery has the advantages of less intraoperative bleeding and shorter surgical duration, which can reduce postoperative anxiety and depression in patients. Postoperative nasal packing may reduce complications, but larger multicenter studies are warranted. Pituitary adenoma patients bear substantial economic and psychological burdens; multidisciplinary collaboration and pharmacoeconomic optimization are needed to reduce overall costs and improve outcomes.