Transition from Microsurgical to Endoscopic Endonasal Resection of Pituitary Adenomas: Early Experience and Learning Curve from a Single-Center Cohort in Vietnam.

Abstract

Endoscopic endonasal transsphenoidal surgery (EETS) is increasingly used for pituitary adenomas, but contemporary outcome data from Vietnam remain limited. We report early outcomes from a tertiary neurosurgical center during the transition from microscopic to endoscopic surgery. We conducted a retrospective consecutive cohort of patients undergoing EETS for histologically confirmed pituitary adenoma at People's Hospital 115 (January 2023-June 2025). Baseline characteristics, endocrine status, magnetic resonance imaging features including Knosp grade, operative details, and outcomes were collected. Extent of resection was assessed by comparing preoperative and early postoperative magnetic resonance imaging and dichotomized as >80% or ≤80% resection. Exploratory early-versus-late phase comparisons used 2-sided Fisher exact tests. Forty-seven patients were included (mean age, 53±12 years; 30/47 [64%] female). Mean maximal tumor diameter was 25±10 mm, and most tumors were nonfunctioning (41/47 [87%]). Resection >80% was achieved in 35/47 (74%). In exploratory chronological analysis, >80% resection was more frequent in the late phase than in the early phase (21/24 [88%] vs. 14/23 [61%]; P=0.049). Visual outcomes were evaluable in 46 patients; 45 of 46 (98%) improved and 1 of 46 (2%) was unchanged. Transient diabetes insipidus was the most frequent complication (13/47 [28%]); postoperative cerebrospinal fluid leak occurred in 2 of 47 (4%). No mortality occurred. During our institutional transition from microscopic to endoscopic endonasal surgery, EETS achieved high rates of >80% resection and excellent early visual recovery with acceptable morbidity. Exploratory chronological comparison suggested a higher rate of >80% resection later in the series, although causal inference cannot be made.