Introduction: Transsphenoidal surgical resection (TSR) is the most common surgical procedure used in the resection of pituitary tumors. There has been an ongoing debate on the effectiveness of two different transsphenoidal methods: endoscopic and microscopic sublabial 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 whereas in 2020, 87% pituitary surgeons preferred the endoscope over the microscope. 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.
Figure 1. Microscopic (A, B) and Endoscopic (C, D) Approaches to Transsphenoidal Pituitary Tumor Resection
Objective: 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 transsphenoidal resection of pituitary tumors between the years 2009 and 2021. Microscopic sublabial and endoscopic approaches were ascertained for all patients and blood loss during surgery was compared between both groups of patients. Surgical 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 of the tumor into the cavernous sinus and suprasellar region, secretory nature of the tumor, as well as patient demographics.
Figure 2. Coronal view of a pituitary tumor
Results: There were 58 cases of microscopic TSR and 38 cases of endoscopic TSR during the study period. Microscopic TSR resulted in a higher average intraoperative blood loss of 310.5±48.6 mL per surgery than 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). There was no difference in the incidence of postoperative CSF leaks between the two groups. No significant differences were observed between the two approaches in hospital length of stay or in extent of surgical resection.
Conclusion: The findings in this retrospective case series showed a 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 provide valuable information comparing the two approaches.