Prospective Comparative Study of Endoscopic versus Microscopic Transsphenoidal Surgery for Nonfunctional Pituitary Adenoma

Transsphenoidal pituitary surgery is an effective way of treating pituitary adenomas. Microscopic transsphenoidal surgery relies on three-dimensional visualization, whereas Endoscopic pituitary surgery has advantage of panoramic visualization and the ability to visualize the opticocarotid recesses and to access suprasellar areas that are not in the direct line of vision during microscopic pituitary surgery.

In the present study we compared endoscopic and microscopic transsphenoidal approaches for pituitary adenoma in relation to outcome and complications.

A total of 50 patients who underwent transsphenoidal surgery for NFPA (25 each group) were included from June 2016 to 2017 in PGIMER after ethical clearance from institute committee. Most common age of presentation was at 5th (38%) and 6th (32%) decade (70%), with male predominance (74%). Most common clinical presentation was painless progressive loss of vision 76% (no = 38) followed by headache 50% (no = 25), menstrual irregularities 18% (no = 9), sudden onset loss of vision and vomiting in 8% (no = 4) and 6th cranial palsy in 6% (no = 3).

Post operatively, visual outcome was better in endoscopic TSS than microscopic TSS for grade 3 tumor (both Hardy’s and Knop’s classification) for grade 2 and grade 4 tumors (both Hardy’s and Knop’s classification) microscopic TSS had better visual outcome, with p-values were > 0.05. Normalization of T3, T4, and serum cortisol on day 5 was slightly more in microscopic TSS group than endoscopic TSS group, but without any statistical significance.

Incidence of arachnoid breach was more common in microscopic than endoscopic TSS (15 vs. 11), in hardy grade-3 tumors, suggested by p-value of 0.045.

Incidence of diabetes insipidus was slightly more in endoscopic TSS (64%) than microscopic TSS (60%) groups, transient DI 52 versus 48% (microscopic vs endoscopic TSS) and permanent DI 8 versus 16% (microscopic vs. endoscopic TSS), but none of the value is significant as the p value is > 0.05.

Postoperative CSF leak occurred in 14% patients (no = 7), more in endoscopic TSS compared with microscopic TSS (5 vs. 2), but statistically not significant as p-value is 0.26.

In our study, GTR was equally achieved in two groups [96% in endoscopic TSS (no = 24) versus 96% in microscopic TSS (no = 24)

Most common age of presentation of NFPA is in the 5th and 6th decades; loss of vision and headache were most common presenting symptoms. Nearly 40% of patients required preoperative hormonal requirement. Tumor was soft and suckable in 82% of cases. Features suggestive of apoplexy as intraoperative finding were present in 24% of cases. Arachnoid breach was more common in microscopic TSS. Statistically, no significant difference was observed between endoscopic and microscopic TSS in terms of visual outcome, hormonal normalization, gross tumor resection, postoperative complications, and incidence of recurrence or residual tumor.