Clinical Outcomes of Microscopic versus Endoscopic Surgical Approaches Following Transsphenoidal Pituitary Tumor Resection

Introduction: Transsphenoidal surgical resection (TSR) is the most common surgical procedure used in the resection of pituitary tumors. There has been discussion of the relative effectiveness of two different transsphenoidal methods: endoscopic and microscopic approaches. Endoscopic TSR has been studied over the past decade and evidence has shown that in 2010, 43% pituitary surgeons preferred the endoscope over the microscope and in 2020, the number went up to 87%. While this finding is suggestive of a growing preference for endoscopic TSR, differences in clinical outcomes between the two approaches have not yet been studied. The purpose of this study was to study the differences in surgical outcomes following pituitary tumor resection in microscopic versus endoscopic resections.

Methods: The VCU Brain Tumor Database was queried for patients who underwent either microscopic or endoscopic transsphenoidal resection of pituitary tumors between the years 2009 and 2021. Outcomes studied included intraoperative blood loss, intraoperative CSF leaks, extent of resection, and hospital length of stay. T-tests and multivariate regressions were performed to control for tumor characteristics such as size, spread into the cavernous sinus and suprasellar region, secretory nature, as well as patient demographics.

Results: Microscopic TSR resulted in a higher average intraoperative blood loss of 310.5±48.6 mL per surgery versus endoscopic TSR (160.0±30.7 mL; p = 0.012). Endoscopic TSR resulted in a higher incidence of intraoperative CSF leaks (36.1%) than microscopic TSR (15.8%; p = 0.043), but no difference in postoperative CSF leaks.

Conclusion : The findings in this retrospective case series showed decreased blood loss during endoscopic pituitary tumor resection, and a decreased incidence of intraoperative CSF leaks in microscopic pituitary tumor resection. This trend suggests that further research in pituitary tumor resection in a prospective controlled manner would be appropriate and would allow for evaluation of additional outcome measures such as patient satisfaction and quality of life.