Sarcouncil Journal of Medical Sciences

Abstract: Pituitary adenomas are the most common tumors of the brain, and surgical treatment has evolved from transcranial craniotomy to an endoscopic endonasal transsphenoidal approach. The aim of this study was to make a comparative analysis of the surgical, hormonal, visual, and safety outcomes between craniotomy and endoscopic endonasal resection in a consecutive cohort of 103 patients with pituitary adenoma. A cross-sectional analysis study was performed to analyze 103 patients undergoing resection of pituitary adenoma, of which 44 patients had transcranial craniotomy and 59 patients had endoscopic endonasal transsphenoidal surgery. Demographic and tumor characteristics, surgical parameters, extent of resection, hormonal and visual results, and postoperative complications. The endoscopic group had significantly smaller tumors and smaller Knops grades at baseline, shorter operative time, less blood loss, shorter hospital stay, and fewer admissions to the ICU. Endoscopic surgery also resulted in the achievement of gross total resection more often compared with open surgery (71.2% vs. 50.0%), and this was an independent predictor of gross total resection. The same was true for the rates for hormonal remission and improvement in visual function, with the endoscopic group showing higher rates of these outcomes than the craniotomy group, although these are not statistically significant. Complication rates were also broadly similar between groups but were numerically higher in the endoscopic group (2.6% for CSF leak, 1.1% for epistaxis) and higher in the craniotomy group (2.0% for hypopituitarism, 2.6% for hematoma), though the latter were not statistically significant. This study demonstrated that the endoscopic endonasal approach was superior in terms of peri-operative efficiency and resection rates in the appropriate selection of tumors, and craniotomy still had a place in the management of larger, more invasive tumors.