EFFICACY AND SAFETY OF ENDOSCOPIC ENDONASAL SURGERY FOR PITUITARY ADENOMAS: SINGLE-CENTER CLINICAL STUDY

Abstract

Introduction: The transsphenoidal endonasal approach has emerged as the most widely adopted technique for primary pituitary surgery. This study aimed to assess the endoscopic endonasal transsphenoidal technique for pituitary adenoma treatment in terms of safety, effectiveness, and surgical outcomes; specifically, it examined the correlation between tumor resection extent and functional recovery following surgery.

Methods: We conducted a single-arm clinical trial on patients undergoing endoscopic endonasal transsphenoidal resection for pituitary adenoma at a tertiary healthcare center. Preoperative assessment included hormonal profiles, radiological evaluation, and ophthalmological examination. Analysis of surgical outcomes included endocrine remission, postoperative complications, clinical improvement, and the incidence of gross total resection (GTR).

Results: The research comprised twenty-five patients, the average age of whom was 37.6 ± 13.1 years. Twenty patients (80%) reported visual impairment as their primary complaint, with headache coming in at ten patients (40%) and diplopia at two patients (8%). Incidental diagnosis was made in one case (4%). Nineteen patients (76%) had gross complete resection (GTR), whereas six patients (24%) underwent subtotal resection (STR). Knosp grading showed that 22 patients (88%) had no or minimal cavernous sinus invasion (Knosp 0–2), whereas 3 patients (12%) had true cavernous sinus invasion (Knosp 3–4), mostly managed with STR. Among the 20 patients with preoperative visual impairment, 11 had visual field deficits only, 3 had decreased visual acuity only, and 6 had both visual field and visual acuity deficits. Improvement was observed in 9 of 11 patients (82%) with visual field deficits only, in 2 of 3 patients (67%) with decreased visual acuity only, and among the 6 patients with both deficits, 4 (67%) improved in both domains, 1 (17%) improved in visual field only, and 1 (17%) showed no improvement. Overall, 16 of the 20 patients (80%) with visual impairment demonstrated postoperative improvement. Headache resolved in 8 of 10 patients (80%), and diplopia improved in 1 of 2 patients (50%). Hormonal remission was achieved in 7 of 11 patients (64%) with functioning adenomas. A statistically significant correlation was observed between the extent of resection and overall clinical outcome. Clinical improvement was more frequent in the GTR group compared with the STR group: headache improved in 87.5% versus 50%, visual function improved in 87.5% versus 50%, and diplopia improved in 100% versus 0% (P = 0.001). Postoperative complications were low. CSF leakage occurred in 2 patients (8%), transient diabetes insipidus in 2 patients (8%), and permanent diabetes insipidus in 1 patient (4%). No cases of meningitis, significant epistaxis, mortality, or postoperative visual deterioration were reported.

Conclusion: Endonasal transsphenoidal resection is a safe and highly effective surgical approach for the management of pituitary adenomas, providing substantial improvement in both visual and endocrine function. Maximizing the extent of tumor resection remains the most important determinant of favorable postoperative clinical outcomes.