Comparative analysis of the effects of microscopic vs. neuroendoscopic transsphenoidal surgery on visual and pituitary function and postoperative recurrence factors in patients with pituitary tumors.

Abstract

Objective: To compare the effects of microscopic and neuroendoscopic transsphenoidal surgeries on visual function, pituitary function, and factors influencing postoperative recurrence in patients with pituitary tumors.

Methods: A retrospective analysis was conducted on 164 patients with pituitary tumors who underwent surgery at The First People's Hospital of Xianyang from March 2020 to March 2022. Based on the surgical approach, patients were divided into an observation group (n=93) and a control group (n=71). The observation group underwent neuroendoscopic transsphenoidal pituitary tumor resection, while the control group underwent microscopic transsphenoidal pituitary tumor resection. General clinical data, perioperative indicators, hormone levels, quality of life, and olfactory function were compared between the two groups. Postoperative recurrence was recorded, and logistic regression analysis was performed to identify factors influencing postoperative recurrence in the patients.

Results: The control group exhibited a greater amount of intraoperative bleeding and a longer postoperative hospital stay compared to the observation group (P<0.0001). The total tumor resection rate was significantly lower in the control group than that in the observation group (P=0.002). Additionally, the numbers of patients in the control group who experienced improvements in vision (P=0.013), headache (P=0.004), and sexual dysfunction (P=0.047) were lower than those in the observation group. One month after surgery, levels of prolactin, human growth hormone, adrenocorticotropic hormone, and thyroid-stimulating hormone were higher in the observation group than those in the control group. The quality of life score one month after surgery was higher in the observation group than that in the control group (P<0.0001). In addition, the olfactory function score one month after surgery was lower in the observation group compared to the control group (P<0.0001). The overall incidence of postoperative complications was higher in the control group (P=0.034). There was no statistically significant difference in recurrence rates between the two groups (P=0.102). Multivariate logistic regression analysis identified tumor size (P=0.001, OR=7.227), Knosp classification (P=0.005, OR=0.238), and Ki-67 index (P=0.001, OR=4.969) as independent risk factors for recurrence within two years in patients with pituitary tumors.

Conclusion: For patients with pituitary tumors, neuroendoscopic transsphenoidal surgery is more effective than microscopic transsphenoidal surgery in reducing operative time and improving postoperative visual and pituitary function, and therefore, should be promoted in clinical practice.