E. Ajmal1, J. Eidlisz1, Z. Qureshi1, R. Kerr2 1SUNY Downstate College of Medicine, BROOKLYN, NY, USA 22) Zucker School of Medicine at Hofstra/Northwell health department of Neurosurgery., Neurosurgery, Huntington, NY, USA
Introduction: Endoscopic pituitary surgery has emerged as a preferred approach for adenoma removal, offering significant advantages over traditional open craniotomy. This review will explore the long-term beneficial quality of life outcomes following endoscopic pituitary adenoma removal compared to open surgery such as craniotomy.
Methods: A PubMed literature review was conducted by searching endoscopic pituitary adenoma resection. The inclusion/exclusion criteria for the review were set by limiting search of articles after 2010. 200 articles were retrieved from PubMed and are being reviewed by two authors to compose a narrative review on the quality-of-life outcomes following endoscopic resection of a pituitary adenoma. Quality of life outcomes for this review include risk for major complications such as CSF leak, meningitis, ischemic stroke, intracranial hemorrhage, vascular injury, visual loss and minor complications such as sinus disease, septal perforations, epistaxis, wound infections and hematomas. It also includes hospital stays, recovery periods, and reliance on medications post-surgery.
Results: Recent studies highlight superior surgical success rates with endoscopic techniques, achieving complete or near-complete tumor resection in over 80% of cases, with mortality rate being less than 0.5% for transsphenoidal surgery. Risk for major complications is between 2-3% and minor complications have demonstrated decreased risk from 6.5% to 1.3% over the last two decades. In addition, retrospective studies have demonstrated relatively high rates of resolution of hormone dysregulation for serum prolactin, growth hormone, and cortisol after microscopic tumor resection (77.4%, 71.8%, and 66.7% respectively), resulting in improved endocrine function and reduced reliance on medications. In contrast, open craniotomy, though effective, is associated with higher complication rates, longer hospital stays, and extended recovery periods4. The minimally invasive nature of endoscopic surgery mitigates these risks, offering faster recovery times and improved patient satisfaction.
Conclusion: This review supports that endoscopic transnasal pituitary adenoma resection techniques represent a substantial advancement in neurosurgical care, providing durable improvements in patient outcomes and quality of life compared to traditional open approaches, when considering extent of resection, complication rates, resolution of hormone dysregulation and reduced length of hospital stay.