Preliminary comparison of the endoscopic transnasal vs the sublabial transseptal approach for clinically nonfunctioning pituitary macroadenomas

Objective: To assess the advantages and disadvantages of an endoscopic tran snasal approach to pituitary surgery for a select group of clinically nonfu nctioning macroadenomas and to compare results of this approach with the su blabial transseptal approach at a single institution. Patients and Methods: We retrospectively reviewed the records of 26 patient s with clinically nonfunctioning pituitary macroadenomas approached endosco pically and 44 matched control patients with the same tumors approached sub labially between January 1, 1995, and October 31,1997. Results: At baseline, the groups were not significantly different for age, sex distribution, number of comorbid conditions, visual field defects, degr ee of anterior pituitary insufficiency, or preoperative assessment of tumor volume or invasiveness. Mean (SD) operative times were significantly reduc ed in the endoscopic group vs the sublabial group: 2.7 (0.7) hours vs 3.4 ( 0.9) hours (P<.001). Postoperative assessment of surgical resection and pos toperative alterations of anterior pituitary function or visual fields were not significantly different between groups, and complication rates were si milar in both groups. Conclusion: This endoscopic transnasal approach to pituitary resection resu lts in significantly shorter operative time without compromising the extent of tumor resection, The distinct disadvantage of this approach is an off-c enter view of the sella and a diminished working channel to the sella turci ca, For these reasons, the endoscopic approach or its variation is an alter native to the sublabial approach but should be considered only by experienc ed pituitary neurosurgeons.