The Comparision of Outcome of Microscopic Versus Endoscopic Trans-sphenoidal Surgery for Pituitary Adenoma

Abstract

Objective: To compare the efficacy of endoscopic transsphenoidal surgery with microscopic transsphenoidal surgery among patients who were operated for pituitary adenomas.
Methods: This randomized control trial was carried out in Neurosurgery Department, Sir Ganga
Ram Hospital Lahore from September 2011 till September 2015. Sample size of 140 (70 in each
group) was estimated and non-probability purposive sampling technique was used. Patients of
pituitary adenomas were randomly selected for each of the procedure and an informed consent
was taken. Two groups of patients were made. Group A patients underwent endoscopic surgery
for pituitary tumor and Group B patients were operated by microscopic technique. After 48 hours
of surgery, patients where be evaluated for radiological evidence of respectability and visual
recovery by undergoing post-operative MRI and visual assessment by ophthalmologist. All the
informations were entered in a structured performa. The data was analyzed by using SPSS
version 25. All qualitative variable like gender, outcome in terms of complete resection and visual
field defects were presented by frequency and percentage. Quantitative data like age was
presented by mean and standard deviation. The groups were compared for outcome using
chisquare test. P values were considered statistically significant if < 0.05.
Results: Out of 140 pituitary adenoma patients, 45% had microadenomas, while 55%
macroadenomas. Mean patients age was 35±10 years. 57% patients were female. Among our
study population, 29.2% patients had visual field defects at the time of presentation. Among 70
patients whose pituitary tumors were resected by endoscopic technique, 70% got complete
resection of tumour, while among 70 patients whose pituitary tumors were resected by
microscopic surgical technique, only 48% got complete tumor resection. (p=0.003). Among 41
patients who had visual field defects, 21 underwent endoscopic resection and 100% (i.e. all 21)
patients showed improvement in visual field defects postoperatively. While 20 patients with visual
field defects underwent microscopic resection, where 80% patients showed improvement in
visual field defects postoperatively (p=0.04).
Conclusions: Our study concluded that endoscopic trans-sphenoidal surgery for pituitary adenoma is much more efficacious than microscopic trans-sphenoidal surgery, as determined by respectability of the tumor and correction or improvement in visual field defects postoperatively. Complete resection will be of value as it will correct other sign and symptoms and hence morbidity and mortality in operated patients as well.