Early Experience With Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas: Clinical Outcomes and Complications

Objective: Endoscopic endonasal transsphenoidal surgery (EETS) has become the preferred method for treating pituitary adenomas; however, it entails a significant learning curve. This study aims to evaluate clinical features, surgical outcomes, and complication patterns during the early institutional experience with EETS and to establish a historical benchmark for tracking the progress of endoscopic pituitary surgery. Methods: This retrospective, single-center observational study included 46 consecutive patients who underwent EETS for pituitary adenomas between October 2008 and September 2010. Data on demographics, clinical presentation, endocrinological and radiologic findings, surgical techniques, reconstruction methods, perioperative complications, and follow-up outcomes were analyzed. Surgical reconstruction was performed using nonvascularized autologous grafts, as contemporary graded closure strategies were not routinely used during the study period. Results: The cohort included 46 patients, 52.2% of whom were male, with an average age of 44.9 years. Macroadenomas made up 71.7% of cases and were frequently associated with suprasellar extension, cavernous sinus involvement, and sellar floor destruction. The most common initial symptoms were headache (65.2%) and visual impairment (45.7%). Endoscopic duraplasty was performed in 50% of patients. Overall, 23.9% experienced complications, with 15.2% experiencing significant ones. Transient diabetes insipidus occurred in 6.5% of cases. The overall mortality rate was 6.5%. A few cases required additional radiotherapy or radiosurgery. The average follow-up period was 9.9 months. Conclusion: This study offers a detailed overview of early institutional experience with EETS for pituitary adenomas, highlighting how the learning curve, tumor complexity, and reconstructive challenges influence surgical outcomes. Although complication rates were higher than those in recent series, the results emphasize the importance of accumulated surgical experience, multidisciplinary teamwork, and advances in closure techniques in meeting current standards of care. Early experiences like this serve as valuable historical benchmarks for guiding training, patient selection, and future surgical innovations.