Long-term quality of life after microscopic and endoscopic transsphenoidal pituitary adenoma surgery: A retrospective cohort study

Transsphenoidal surgery is the primary treatment for pituitary adenomas, yet the long-term quality of life (LTQoL) outcomes following microscopic transsphenoidal surgery (MTSS) and endoscopic transsphenoidal surgery (ETSS) remain underexplored. This study compared postoperative complications and LTQoL (>24 months) between these two approaches. This retrospective study analyzed 103 patients who underwent their first transsphenoidal pituitary adenoma resection at Beijing Tiantan Hospital (2015–2022). Patients were categorized into the MTSS group (n = 55) and ETSS group (n = 48). LTQoL was assessed using the Anterior Skull Base Questionnaire (ASBQ) and Sino-Nasal Outcome Test-22 (SNOT-22). Statistical analyses were performed to compare postoperative complications and LTQoL outcomes. No significant differences were observed in postoperative infections (P = 0.566), diabetes insipidus (P = 0.414), vision recovery (P = 0.064), and hyponatremia (P = 0.931). However, ETSS had a higher cerebrospinal fluid (CSF) leakage rate (16.7 % vs. 3.6 %, P = 0.042) but a significantly higher gross-total resection (GTR) rate (83.3 % vs. 25.5 %, P < 0.05). Regression analysis showed SNOT-22 scores were associated with surgical approach, cavernous sinus invasion, cerebrospinal fluid (CSF) leakage, and visual deterioration. Tumor size and hospital stay negatively impacted both ASBQ and SNOT-22 scores, while PIT1-lineage tumors were protective for ASBQ scores. Both MTSS and ETSS are effective, but ETSS is preferred for tumors extending beyond the sella due to its higher GTR rate and better nasal-related LTQoL, despite an increased risk of CSF leakage.