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Endoscopic vs. microscopic transsphenoidal surgery outcomes in 514 nonfunctioning pituitary adenoma cases

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Abstract

Transsphenoidal surgery remains the preference choice for patients with nonfunctioning pituitary tumors at present, but the superiority of surgical modalities is still debated. Moreover, the efficacy of microscopic and endoscopic transsphenoidal surgery has not been fully studied. Therefore, the present study was designed to compare the postoperative outcomes of the two widely used approaches worldwide. This retrospective study included 514 patients with the first transsphenoidal pituitary adenoma resection in Shandong Provincial Hospital from January 2015 to July 2020 and compared the outcomes of microscope transsphenoidal surgery (MTSS) and endoscopy transsphenoidal surgery (ETSS). A total of 514 patients were included in this study, of whom 210 received the ETSS and 304 received the MTSS. The patients in two groups were similar in terms of postoperative hyponatremia (p = 0.229), diabetes insipidus (p = 0.264), the recovery of hormonal axis (p < 0.05), and extent of resection (EOR) (p = 0.067). ETSS was more likely to cause cerebrospinal fluid leakage than MTSS (p = 0.017, 3.6% vs. 8.6%). CSF leakage might be related to tumor size (95% CI = 1.305–2.766, p = 0.001), and the surgeon’s transsphenoidal surgery volume < 300 was also a risk factor (95% CI = 1.396–9.067, p = 0.008). The effect of different surgeries on postoperative vision improvement was statistically difference in univariate analysis (p = 0.048) but not after adjustment for confounders (p = 0.112). Furthermore, there were statistical difference in EOR between MTSS and ETSS when adenomas were performed suprasellar extension (p = 0.037) or optic chiasm compression (p = 0.045). Both techniques are valid for the treatment of nonfunctional adenomas. But CSF leakage is more likely after ETSS. In addition, ETSS is more conducive to resection of nonfunctional adenomas with suprasellar extension or optic chiasm compression.

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Data availability

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

All data were analyzed using SPSS (version 21.0, IBM Corp.).

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Funding

The work was supported by National Natural Science Foundation of China (81970685, 81000323) and Key Research and Development Plan of Shandong province (2016GSF201007).

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Authors and Affiliations

  1. Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China

    Shuaihua Song & Qianjin Qi

  2. The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China

    Linping Wang

  3. Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China

    Haoran Wang

  4. Department of Clinical Nutrition, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China

    Li Feng

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  1. Shuaihua Song
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  5. Li Feng
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Contributions

LPW and LF conceived and designed this research. QJQ and HRW collected and reorganized the data. SHS analyzed the data and drafted the manuscript. LPW and LF reviewed the important intellectual critically. All authors read and approved the manuscript.

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Correspondence to Li Feng.

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This research was conducted after approval by the institutional review board of Shandong Provincial Hospital. Because this represented a retrospective research, the requirement for written informed consent was waived.

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Song, S., Wang, L., Qi, Q. et al. Endoscopic vs. microscopic transsphenoidal surgery outcomes in 514 nonfunctioning pituitary adenoma cases. Neurosurg Rev 45, 2375–2383 (2022). https://doi.org/10.1007/s10143-022-01732-4

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