Transition From Microscopic to Endoscopic Transsphenoidal Surgery: Challenges, Advantages, and Early Surgical Outcomes

Objective: The aim of this study was to evaluate the early clinical and surgical outcomes during the transition from microscopic transsphenoidal surgery to the endoscopic endonasal transsphenoidal approach. Materials and methods: This retrospective study included the first 10 consecutive patients with pituitary tumors who were operated on using the endoscopic endonasal transsphenoidal approach by a surgical team experienced in microscopic transsphenoidal surgery. All procedures were performed by the same multidisciplinary team using a four-hand technique in collaboration with an otorhinolaryngologist. Patients were evaluated in terms of demographic characteristics, tumor type and size, cavernous sinus invasion, extent of resection, complications, and early clinical outcomes. Results: Seven patients were male, and three were female, with a mean age of 52.5±13.1 years. Histopathological examination revealed non-functioning pituitary neuroendocrine tumor (pitNET) in three patients, gonadotroph pitNET in four patients, corticotroph pitNET in two patients, and somatotroph pitNET in one patient. Cavernous sinus invasion was observed in four patients. Early postoperative imaging demonstrated residual tumor in two patients, whereas gross total resection was achieved in eight patients. Intraoperative cerebrospinal fluid leakage occurred in three patients; one patient required additional surgical intervention for a postoperative cerebrospinal fluid fistula. No major vascular complications were observed. Permanent diabetes insipidus developed in one patient. The mean operative time was 4.5±0.6 hours, and the mean intraoperative blood loss was 178±15.5 mL. Conclusion: During the early phase of the transition from microscopic to endoscopic endonasal transsphenoidal surgery, acceptable surgical outcomes can be achieved with appropriate patient selection and a multidisciplinary team approach. These findings suggest that the endoscopic technique can be safely implemented even in the early stages of the learning curve.