The Role of Comprehensive Structural Preservation Strategy in Skull Base Reconstruction Following Endoscopic Endonasal Surgery for Pituitary Neuroendocrine Tumors: A Retrospective Single-Center Study.

Abstract

This study aims to evaluate and compare the surgical outcomes of endoscopic endonasal surgery (EES) for pituitary neuroendocrine tumors (PitNETs) using two surgical approaches: the comprehensive structural preservation strategy based on transseptal approach (CSP-TSA) and the traditional transnasal approach (TNA). We retrospectively analyzed 62 patients who underwent EES for PitNETs at our center between March 2021 and September 2024. Patients were categorized into CSP-TSA (n = 32) and TNA (n = 30) groups based on the surgical approach. Outcomes assessed included tumor resection extent, biochemical remission rate of functional PitNETs, visual function improvement rate, and postoperative cerebrospinal fluid (CSF) leakage rate between the two groups. Statistical comparisons were performed to evaluate differences between the two groups. A total of 62 patients were included in the study, with 30 undergoing TNA and 32 undergoing CSP-TSA. The two groups were well-matched in terms of baseline demographic and clinical characteristics. Both approaches achieved comparable rates of gross total resection, hormonal remission, and visual function improvement. However, significant differences were observed in postoperative CSF leakage rates (0% in CSP-TSA vs. 13.3% in TNA; P = 0.049). The CSP-TSA demonstrated equivalent efficacy in tumor resection and functional outcomes compared to TNA, while significantly reducing postoperative CSF leakage and overall complication rates. The protective reconfiguration of the anterior wall of the sphenoid sinus, in-situ bone flap of the sellar floor, and sphenoid mucosal flap may enhance skull base reconstruction in CSP-TSA, highlighting its potential as a superior strategy for structural preservation in EES for PitNETs.