Comparative Study between Endoscopic and Microscopic Trans-Sphenoidal Excision of Pituitary Adenoma

Objective: The aim of this work is to compare between endoscopic and microscopic trans sphenoidal approaches in resection of pituitary adenomas.Methods: This study included 30 patients with pituitary adenomas, they were operated upon by trans sphenoidal excision either microscopic or endoscopic. Postoperatively, patients were evaluated and both approaches are compared as regard to tumor resection, hormonal level improvement, visual acuity and field, CSF leak and nasal complications.Results: The median age of presentation in this study was 33 years. There was 16 female (53%) and 14 males (47%). In this study the main presentation was visual deterioration in 27 patients (90%), followed by headache in 25 patients (83%), followed by endocrinal manifestations in 16 patients (53%). Non secretory pituitary adenoma was the most common type (47%), followed by prolactinomas (36.5%), followed by GH secreting adenomas (16.5%). Postoperatively, total resection was achieved in 11 patients in endoscopic group (73.5%) versus 8 patients in microscopic group (53.5%). Improvement of visual acuity was (80%) in endoscopic group versus (60%) in microscopic group. Improvement of visual field was (83%) in endoscopic group versus (50%) in microscopic group. Improvement of headache was (92%) in endoscopic group versus (91.5%) in microscopic group. Postoperative nasal complications occurred in (20%) in endoscopic group versus (73.5%) in microscopic group.Conclusion: Endoscopic trans sphenoidal approach is better than microscopic because it allows maximal tumor resection and minimize the incidence of complications.