Endoscopic Endonasal versus Microscopic Trans-Sphenoidal Surgery for Recurrent Pituitary Adenomas: Comparative Study

Abstract Background: Pituitary adenoma is a common brain tumor. It accounts for 10-25% of all intracranial tumors. Treatment of recurrent pituitary adenomas is often surgi-cally either endoscopic or microscopic with the advantages of endoscopic approach due to visualization of residual tumor and limited field of view of the microscope. Aim of Study: The aim of this study was to compare the efficacy and results of endoscopic and microscopic trans-sphenoidal surgery of recurrent pituitary adenoma. Patients and Methods: This is prospective study was carried out on 34 patients of recurrent pituitary adenomas at Neurosurgery Departments, Al-Azhar University Hospitals and Mohammed Dossary Hospital Al-Khobar, KSA. Adult patients who had tumor recurrence or residual tumor underwent revision surgery. While those underwent radiother-apy/radio surgery or receiving medical therapy for remission were excluded. Patients were classified into group A subjected to endo-scopic removal and group B subjected to microscopic resection of the recurrent pituitary adenoma. All patients in the study were subjected to clinical, imaging and laboratory studies for the diagnosis and extent of the tumor. Results: Our results revealed no difference between both groups regarding gender of age (p=0.412 and 0.631 respec-tively); presenting symptoms (p=0.413). Operative time was significantly longer in group B (p=0.01) and intraoperative blood loss was much in group B (p=0.02). Endoscopic removal of macro adenomas is significantly more than microscopic approach (p=0.032) also, complete excision of tumor in endoscopic approach is significantly more than microscopic approach (0.035). Also, the readmission rate and late complications were more in group B than groups A but without difference (p=0.241 and 0.351 respectively) also, there was no difference between groups regarding total hospital stay (p=0.601). Conclusion: Reoperation for recurrent or residual pituitary adenomas is a safe and effective treatment option. Endoscopic approach more effective than microscopic approach due to wide orientation, more resection, less operative and postop-erative complications with shorter hospital stay.