A COMPARATIVE STUDY BETWEEN ENDONASAL ENDOSCOPIC AND MICROSCOPIC TRANSSPHENOIDAL APPROACHES IN MANAGEMENT OF PITUITARY ADENOMAS

Abstract

Background: Advances in the era of modern micro-neurosurgery enabled a reduction of surgical invasiveness and brain retraction which has been defined as minimally invasive or keyhole surgery. Sinonasal endoscopy has brought radical changes in the concepts of pathophysiology and treatment of sinonasal diseases as well as surgical techniques. \nObjective: Assessment of patient outcomes regarding transsphenoidal endoscopic and microscopic approaches of pituitary adenomas. \nPatients and methods: Our study included 40 cases of pituitary adenomas, operated upon during 2 years, half of them (group A; 20 cases) underwent endoscopic endonasal transsphenoidal pituitary adenoma resection, while the remaining (group B; 20 cases) operated upon using the standard microscopic transseptal transsphenoidal pituitary adenoma resection. \nResults: The highest age incidence of our cases was during the third and fourth decades of life, with a male to female ratio of nearly 1:1. Headache was the commonest presenting symptom in our series both in endoscopic and microscopic groups; (60%& 70%) respectively followed by visual impairment; (55%& 60%). Although, loss of libido was the most common endocrinopathies; (75%& 60%) respectively. In our study CT-sella with coronal cuts was the initial radiographic investigation, performed in all our cases. It gave an idea about bony anatomy of the sella, sphenoid sinus, and particularly was important in showing the position of the sphenoid sinus septum, which was crucial in planning the decision of operation. In our study, improvement in out-come was higher in endoscopic group opposed to microscopic group (100% vs. 71% improved headache, 82% vs. 58% visual improvement and 80% vs. 55% total tumor removal ). \nConclusion: Endoscopy offers a very special and wide visualization, close to the target and inside the anatomy. The panoramic view provided by the endoscope, allowing the identification of all the landmarks around the sella during the entire procedure, minimizes the chance of an inaccurate orientation.