Microscopic versus endoscopic transnasal pituitary surgery

Abstract

The transnasal endoscopic approach to the sella turcica is an alternative to the microscopic approach and over the last decade has come into prominence as a new technique. In the present article, we will analyze the current literature on outcomes between the two techniques. The endoscopic approach to the pituitary has redefined visualization of the sella. The panoramic view afforded by the endoscope is unparalleled as compared with the traditional conical view of the microscope. This technique has been shown to have a statistically significant reduction in operative time and length of hospital stay. There is also a trend toward improved endocrine outcomes and rate of return of visual defects. These two approaches are equally efficacious in oncological outcomes and the complication rates are comparable. With longer follow-up of this developing field it may be shown that complication rates are decreased, surgical reconstruction is less time consuming, and tumor resection is more complete due to improved visualization in the sellar and parasellar areas. In addition, the use of endoscopes facilitates extended approaches, reaching a myriad of skull base lesions that are suprasellar, retrosellar, and parasellar, which permits visualization beyond the abilities of the microscope.