Comparison of endoscopic and endoscope-assisted microscopic transsphenoidal surgery for pituitary adenoma resection: a prospective randomized study

Márton Eördögh^1,2*Laszlo Bárány³Christian Rosenstengel²Victoria Bogaczyk²Jörg Baldauf²Silke Vogelgesang¹Andreas Stahl¹Michael Kirsch¹Werner Hosemann¹Antje Steveling¹Ahmed Al Menabbawy²Henry W.S. Schroeder^1,2

• ¹Universitätsmedizin Greifswald, Greifswald, Germany
• ²Department of Neurosurgery, University Medical Center Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
• ³Department of Neurosurgery, University Hospital Erlangen, Erlangen, Bavaria, Germany

Objective: The value of the endoscopic versus microsurgical approach has not yet been defined in transsphenoidal pituitary adenoma surgery. In this study, we compare both methods and analyze the long-term surgical, radiological, endocrinological, ophthalmological, rhinological results as well as the patients´ quality of life.Methods: 33 individuals with elective transsphenoidal pituitary adenoma surgery were randomized (pure endoscopic approach or endoscope-assisted microscopic approach) and prospectively underwent investigations with focus on patient-related subjective outcome measurements.The mean follow-up period was 6.3 years. In the microsurgical group, endoscopic inspection revealed residual tumor in 7 of 15 patients (46.7%) not seen by the microscope.Endoscopic resection provided long-term tumor-free state in all of them. Compared to pure microsurgical treatment, endoscopy was associated with lower probability of tumor recurrence (OR=0.24) and appeared advantageous in long-term achievement of any surgical goal (OR=3.80) as well as in anterior pituitary lobe function improvement (OR=1.60). Where gross total tumor resection was the stated preoperative goal, there was no long-term tumor recurrence in 81.8% (endoscopy group) and 83.3% (endoscope-assisted microsurgical group). Most aspects showed no significant difference between the techniques, such as: length of hospital stay, complication rate (endoscopy: 16.7%, endoscope-assisted microsurgery: 20.0%), long-term maintenance of any preoperatively stated extent of resection, pituitary and olfactory function, rates of DI and SIADH, ophthalmological improvement, SNOT scores.Conclusions: Both techniques provide good long-term surgical, radiological, endocrinological, rhinological and ophthalmological results. Endoscopy clearly improved the rate of long-term achievement of the initial surgical goal and the anterior pituitary lobe function.