Surgical outcome of non-functioning pituitary adenomas: a comparative study between microscopic and endoscopic techniques

Abstract Background Non-functioning pituitary adenomas have been treated by gross total resection with the microscopic transsphenoidal approach being the standard for decades. Recently, the endoscope has been utilized as alternative with its possible advantages and disadvantages. Methods In this study, the authors retrospectively reviewed 58 cases who underwent transsphenoidal non-functioning pituitary adenomas resection, 25 via the microscopic approach (group 1) and 33 via the endoscopic approach (group 2). Different aspects of the procedures were compared, including duration of surgery, incidence of post-operative cerebrospinal fluid leak (being one of the common complications after such procedures), length of hospital stay postoperatively, and most importantly the tumor volume reduction being measured in a novel method by creating a computer-generated three-dimensional reconstruction of the tumor. Results The length of hospital stay for group 1 ranged from 2 to 9 days (mean 3.6 days, SD 2.141) while in group 2, it ranged from 2 to 7 days (mean 3.727 days, SD 1.008). Operative time mean was 92.7 min in group 1 and 142.79 min in group 2. Intraoperative CSF leak was encountered in 40% (n = 10) of the cases in group 1 and in five cases (15.2%) from group 2. Volume reduction percentage had a mean of 82.4% in group 1 and 89.1% in group 2. Although the mean of volume reduction percentage was higher in group 2, yet this difference was found to be statistically insignificant with a p value of 0.141. Conclusion Endoscopic approach showed superiority by having lower incidence of post-operative cerebrospinal fluid leak, length of hospital stay, and tumor volume reduction while the microscopic approach was only favored in having shorter mean duration of surgery