Outcome Comparison in Microscopic and Endoscopic Trans-Sphenoidal Pituitary Adenoma Surgery in Terms of Extent of Resection

The current standard interventions for pituitary adenomas are transsphenoidal surgery by endoscopic or microscopic approaches. However, the superiority of efficacy and safety of the two surgical procedures remain controversial. This study compared the outcome of endoscopic and microscopic transsphenoidal pituitary adenoma surgery by randomized controlled trial method. It is done in Department of Neurosurgery, Lahore General Hospital, Lahore for a period of 12 months. Total N=60 patients were enrolled, patients were randomly divided in two groups by using lottery method. In group A, patients undergone transsphenoidal pituitary adenoma surgery through endoscopic approach while in group B, patients undergone transsphenoidal pituitary adenoma surgery through microscopic approach. During and after surgery CSF leakage and resection in terms of gross total, subtotal and partial were noted. Patients were followed-up in OPD. At 6 weeks, visual field of patients were assessed and improvement was noted. A predesigned proforma was used to collect information. Visual field improvement was slightly higher in patients who were operated via microscopic approach as compared to those with endoscopic approach but the difference in both the groups is insignificant i.e. Group-A: 95.7% vs. Group-B: 96% (p-value>0.05). Regarding CSF leak, the difference was observed was insignificant in both treatment groups i.e. Group-A: 13.3% vs. Group-B: 16.7% (p-value>0.05). Gross total resection (GTR) was seen in 73.3% and subtotal resection (STR) in 26.7% patients who were operated with endoscopic approach while patients who were operated with microscopic approach, GTR was in 66.7% and STR in 33.3% patients (p>0.05) which is insignificant. Both treatment modalities are nearly equally effective in treating pituitary adenoma. Although with endoscopic approach comes up with higher gross total resection of pituitary adenoma.