gms | German Medical Science

Objective: Currently, the most frequently used surgical approach to pituitary lesions is the transseptal transsphenoidal microscopic approach. The endonasal transsphenoidal fully endoscopic approach is however rapidly gaining popularity and has been adopted by increasing numbers of pituitary surgeons. We present our results with both techniques in comparison.

Method: The 2-year outcome of 58 consecutive and unselected patients with different types of pituitary adenomas operated by the biportal transsphenoidal endoscopic approach was compared with the 2-year outcome of 35 unselected and consecutive patients who underwent surgery by the sublabial transseptal transsphenoidal microsurgical approach. Length of surgery, intraoperative placement of lumbar drains, rates of intraoperative and postoperative CSF leaks and fistulas in need of surgical repair, and 2-year adenoma recurrence rates were compared in both groups.

Results: Compared to the standard microsurgical group, patients after endoscopic surgery had similar mean length of procedure, somewhat lower total blood loss, and less nasal pain and discomfort. The incidence of intraoperative CSF leaks was significantly higher in the endoscopic group, however the number of patients who required surgical revision of a CSF fistula was not significantly different in both groups (5% each). Early postoperative MRI scans demonstrated significantly higher percentages of radical tumor removal in the endoscopic group (90%) vs. microsurgery group (64%), p<0.01. The 2-year recurrence rate in the endoscopic group was low (3.5%) and not significantly different from that of the microscopic group (5.1%).

Conclusions: Fully endoscopic pituitary surgery results in fewer nasal complications. For the surgeon, the fully endoscopic view is incomparably more wide-angled than the microscopic view. It allows 360° intrasellar inspection with removal of residual tumor in areas not visible during microsurgery. In addition, endoscopy obviates the need for intraoperative fluoroscopic control. In our hands, the fully endoscopic endonasal transsphenoidal approach has produced at least comparable if not better results than microsurgery for pituitary adenoma. Both techniques resulted in similar recurrence rates at 2 years, but 5- and 10-years recurrence data need to be collected due to the benign and slow growing nature of pituitary adenomas.