A comparative study of Endoscopic versus Navigation guided microscopic transsphenoidal pituitary surgery at Tertiary care Centre in India

Introduction: The transsphenoidal route for pituitary surgery is considered the standard treatment for pituitary adenomas. The disadvantage of the smaller exposure of this route is partially compensated for by the introduction of the microscope with its coaxial illumination, stereoscopic view, adequate magnification, and microsurgical instruments. However, there are only few reports about the outcome of endonasal endoscopic transphenoidal technique.Aims & Objectives: Current study has been conducted to compare the efficacy, advantages and dis advantages of endoscopic versus navigation guided microscopic transsphenoidal Pituitary surgery.Material and methods: A controlled study was done in the department of neurosurgery, at tertiary care hospital in India, from the period of August 2012 to December 2017 prospectively. In Group A- 30 patients in whom endoscopic transnasal trans Sphenoidal pituitary surgery and in Group B - 30 patients, intraoperative neuronavigation was used.Observations and Results: Both the groups were similar in demographic variables. The most common age group of pituitary tumor patients was 30-40 years. Fourteen (46.6 %) patients in group A and fifteen (50 %) of the patients in group B had tumor volume less than 5 ml. In group A, thirteen (43%) patients had intrasellar tumors with no suprasellar extension, while in group B, fifteen (50%) patients had intrasellar tumors with no extension. Operative time was noted from incision to closure and average time taken in both the groups was compared. Twenty five (83%) cases of group A took between 2-3 hours and only four cases (13%) took more than 3 hours. While in group B, twenty (66%) cases took between 4-5 hours. This shows a significant difference by fisher extact test (p<0.001) in the operative time required in both the groups. Eighteen (60%) patients in group B had a residual volume between 1-1.5 ml while only two patients in group A had so. This difference is also significant Fischer Exact test (p<0.001). Four (13.3%) patients in group A had diabites insipidus while only half of this, i.e. two (6.6%) had so in group B. however this difference in postoperative complication rate is not statistically significant between two groups.Conclusion: The results of our study correlate with many previous studies to compare endoscopic and microscopic transsphenoidal surgery. These two approaches are equally efficacious in oncological outcomes and the complication rates are comparable