Comparative Study between Microscopic and Endoscopic Endonasal Trans-Sphenoidal Surgeries for Nonfunctioning Pituitary Macro-Adenomas

Document Type : Original Article

Authors

1 Department of Neurosurgery, Damanhur National institute, Egypt

2 Department of Neurosurgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt

Abstract

Background: The transsphenoidal surgery has emerged as the standard treatment of pituitary adenomas. The endonasal transsphenoidal approach either microscopic or endoscopic affords a rhinological recovery with fewer sinonasal complaints.
Aim of the work: Comparison between microscopic and endoscopic endonasal trans-sphenoidal approaches in nonfunctioning pituitary adenomas.
Patients and Methods: Thirty patients with nonfunctioning pituitary adenomas were included from March 2015 to October 2020. The patients were subdivided into two groups, Group [A]: 15 patients for an endoscopic endonasal transsphenoidal approach, and Group [B]: 15 patients for microscopic endonasal transsphenoidal approach. All patients were subjected to history taking, general and neurological examination, visual, rhinological, endocrine and radiological assessment. All patients were followed up and examined by an attending neurosurgeon, otolaryngologist and endocrinologist one and three months and then yearly thereafter. The data were obtained and recorded. Complete tumor resection was the primary outcome. Other secondary outcomes included operative data and postoperative complications.
Results: Operative time ranged from 60.0 - 150.0 minutes [mean 108.0 and 88.0 minutes in groups A and B respectively]. Complete tumor resection achieved in 13 patients [86.7%] of group A compared to 10 patients [66.7%] in group B. Subtotal tumor resection achieved for 2 patients [13.3%] and 3 patients [20%] of groups A and B, respectively.  Partial resection and insufficient removal was reported in one patient [6.7%] for each in group B.
Conclusion: The endoscopic endonasal approach provides more favorable tumor removal, and hence was associated improved visual field and acuity, less postoperative pain and shorter hospitalization.

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