Clinical Outcomes in Trans-sphenoidal Surgery for Pituitary Neuroendocrine Tumour in Sarawak General Hospital, Malaysia: Microscopic Versus Endoscopic Approach

Purpose: Trans-sphenoidal surgery is the standard approach to provide direct access to pituitary neuroendocrine tumours (PitNET). Reported outcomes for trans-sphenoidal surgical resection of PitNET were heterogeneous. This work aimed to develop local data for the outcomes of trans-sphenoidal surgery, either via a microscopic or endoscopic approach. Methods: We performed a retrospective review of patients with PitNET treated by trans-sphenoidal surgery at Sarawak General Hospital from 2014-2021. We included only cases treated by the senior author (AWSH) to avoid inter-surgeon variability. Demographic, clinical, radiologic, operative, and postoperative outcome data were analysed. Results: There were 60 patients, with 35 patients in the microscopic group and 25 in the endoscopic group. The baseline characteristics were comparable. The rate of gross total resection was similar (34.4% vs 44.0%, p=0.459) in both approaches. The endoscopic approach was observed to have a higher proportion of patients with arachnoid breach than the microscopic approach (p=0.010). However, the endoscopic approach had a significantly higher proportion of patients with improved anterior pituitary gland function than the microscopic approach (p=0.006). There was low morbidity, with a meningitis risk of 2.9% in the microscopic approach vs. 4.0% in the endoscopic approach (p>0.950). There was no mortality observed in our study. During follow-up, we found that 83% of patients with residual volume remained radiologically stable and clinically asymptomatic and did not require a second surgery. Conclusion: Our study showed that trans-sphenoidal surgery, either with a microscopic or endoscopic approach, was safe for the resection of PitNET. The endoscopic approach has a better outcome in anterior pituitary function improvement. There was no difference in the extent of resection and visual improvement. Postoperative meningitis risk was equally low, and there was no mortality in our transsphenoidal series.