Evaluating the Effectiveness of Endoscopic and Transcranial Techniques in Pituitary Tumor Resection: A Single-Institution Study

Abstract

Background: Transsphenoidal pituitary operations are conducted using microscopic and endoscopic techniques.
The microscopic technique provides three-dimensional visualization and follows established procedures based
on transsphenoidal approaches. This study compared the clinical efficacy and safety of endoscopic transnasaltranssphenoidal surgery (ETTS) with that of traditional transcranial/microscopic methods for pituitary adenoma.
Methods: Eighty patients were divided into two groups: the ETTS (n = 40) and transcranial surgery (TCS)
(n = 40) groups. The evaluation criteria included the extent of tumor removal, hormonal remission in functioning
tumors, visual outcomes, perioperative complications, surgery duration, and length of hospital stay. Results: The
ETTS group demonstrated significantly smaller residual tumor volumes (6.6% vs. 24.6%, P = 0.002) and higher
remission rates for functioning adenomas (94% vs. 57%, P = 0.018) than the TCS group. Visual outcomes were not
significantly correlated with tumor size or residual volume in either group. The ETTS group had a lower incidence
of post-operative diabetes insipidus (4 vs. 11 patients, P = 0.025) and shorter hospital stays for patients with
hormonally active tumors (3.7 ± 2.0 vs. 7.1 ± 3.5 days, P = 0.005). However, the ETTS required longer surgery
times (202 ± 34 vs. 169 ± 50 min, P = 0.001). The rates of post-operative cerebrospinal fluid leakage and repeat
surgeries did not differ significantly between the groups. Conclusion: These findings suggest that ETTS is a safe
and effective method for treating pituitary adenomas, offering better tumor removal, hormonal remission, and
post-operative recovery than traditional methods. However, larger multicenter studies with extended follow-up
are required to validate these results.