Comparison of endoscopic and microscopic transsphenoidal pituitary surgery for managing growth hormone-secreting adenomas

Abstract

Pituitary adenomas are benign tumors with various biological behaviors, including hormonal secretion, cavernous sinus invasion and others. This study aimed to access the advantages and disadvantages of the endoscopic endonasal transsphenoidal (EET) approach for managing growth hormone-secreting adenomas in achieving clinical remission compared to the microscopic endonasal transsphenoidal (MET) approach. From 2017 to 2020, a series of 29 patients with growth hormone-secreting adenomas (GH) underwent the surgical treatment via MET (n = 13) and EET (n = 16) approach. Preoperatively and postoperatively endocrinological, neuro-ophthalmological and magnetic resonance imaging (MRI) examinations were performed. According to the Knosp classification for cavernous sinus, 34.4% of all adenomas were accessed as invasive. The mean follow-up was 21.6 ± 12.2 months. The endocrinological remission in the whole group was 68.9%. The microscopic group had lower levels of remission in comparison to the endoscopic group (61.53% vs. 75%). However, no significant difference was observed (р > 0.05). Postoperative diabetes insipidus and cerebrospinal fluid (CSF) leaks rates had a similar occurrence in both groups. No other significant complications were recognized. The use of endoscopic approaches provides a couple of advantages, such as wider field of view, superior illumination and better maneuverability compared to conventional microsurgery. A longer follow-up is still needed for further evaluation of our results.

Keywords

• growth hormone-secreting adenomas
• endoscopic approach
• microscopic approach