The Endoscopic versus the Traditional Approach in Pituitary Surgery

TLDR

The transsphenoidal route is the most widely used technique for pituitary adenoma surgery because it is rapid, well tolerated, effective, and has a low complication rate. The study compared endoscopic and microscopic transsphenoidal surgery using data from 418 patients, analyzing 381 with follow‑up, and attributed improved outcomes to the endoscope’s superior visualization and the flexible trajectory lacking a divaricator. Endoscopic transsphenoidal surgery was rapid, well tolerated, and had a low complication rate, matching microsurgical outcomes for endosellar lesions and outperforming microsurgery in removing extrasellar tumors.

Abstract

The transsphenoidal route is the most widely used technique for pituitary adenoma surgery due to its rapidity, good tolerance, effectiveness and low complication rate. These are the parameters we utilized in comparing endoscopic with microscopic transsphenoidal surgery. We reviewed the medical records of 418 patients affected by pituitary adenomas who underwent endoscopic transsphenoidal surgery between May 1998 and December 2004, and in this paper, we present the results of 381 patients who fulfilled the follow-up criteria after a minimum period of 15 months. Our experience confirms the previous data on the rapidity and satisfactory tolerance of the endoscopic procedure. We also confirm the low complication rate, specifying that complications characteristic of the approaching phase were certainly reduced; instead, complications characteristic of tumor removal still remained similar to those reported in the microsurgical literature. The results were comparable with those of the best microsurgical series regarding endosellar lesions, but tumor removal was notably superior when dealing with tumors having an extrasellar extension. The improvement may be explained by the excellent vision of the deep surgical fields due to the endoscope and by the extreme flexibility of the surgical trajectory, mainly due to the absence of the divaricator, giving access to the ramifications of the tumor, otherwise difficult to reach.