Results of endoscopic endonasal transsphenoidal surgery for pituitary adenoma

Objective: To evaluate short- and mid-term outcomes of endoscopic endonasal transsphenoidal surgery for pituitary adenoma.

Material and methods: In this prospective, single-center observational study (2020–2024), a total of 72 consecutive patients with pituitary adenomas underwent endoscopic endonasal transsphenoidal adenomectomy at the National Medical Center of the Republic of Tajikistan “Shifobakhsh.” Median age was 33.5 years [22.0–37.0] (range 17–63). Of these patients, 29 (40.3%) were men and 43 (59.7%) were women. Preoperative assessment included a hormonal panel (including prolactin), contrast-enhanced brain MRI, and neuro-ophthalmologic examination; tumor extension and cavernous sinus invasion were graded using the Hardy and Knosp classifications, respectively. Primary outcomes included extent of resection on MRI, control of hyperprolactinemia, visual outcomes, and adverse events, assessed over a follow-up period of 3–24 months. Statistical analysis was performed using R (version 4.5.2). Continuous variables are reported as median [Q1–Q3], and categorical variables as n (%).

Results: Macroadenomas accounted for 70 (97.2%) cases; visual impairment was present in 50 (69.4%) patients. Gross total resection was achieved in 64 patients (88.9%; 95% CI 79.6–94.3%), and subtotal resection in 8 (11.1%). Prolactin normalization after surgery (with adjuvant medical therapy) was documented in 63 patients (87.5%; 95% CI 77.9–93.3%) and was more frequent after gross total resection (60/64) than after subtotal resection (3/8; p < 0.001). Visual improvement was observed in 14 of 50 patients (28.0%; 95% CI 17.5–41.7%) and was associated with shorter symptom duration (p < 0.001). Follow-up data were available for 55 patients (76.4%); tumor recurrence was detected in 2 of these patients (3.6%), and there were no postoperative deaths.

Conclusion: Endoscopic endonasal transsphenoidal surgery provides high rates of gross total resection and control of hyperprolactinemia, with zero mortality. Standardized reporting of specific complications and longer follow-up are needed to better characterize safety and recurrence risk.

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