Surgical Outcomes in Pituitary Adenomas in a Resource-Limited Tertiary Government Hospital: A Five-Year Retrospective Cohort Study

Introduction Pituitary adenomas are among the most commonly encountered intracranial neoplasms requiring surgical intervention. Although endoscopic endonasal transsphenoidal surgery has become the preferred minimally invasive approach, open transcranial surgery continues to be indicated for selected invasive or anatomically complex lesions. Comparative outcome data from resource-limited tertiary institutions are still scarce. Therefore, this study aimed to evaluate the clinico-demographic characteristics and perioperative outcomes of patients with pituitary adenoma who underwent open or endoscopic pituitary surgery at a tertiary government hospital over five years. Methods A retrospective cohort descriptive-analytic study was conducted involving patients diagnosed with pituitary adenoma who underwent either open transcranial surgery or endoscopic transnasal transsphenoidal surgery at Vicente Sotto Memorial Medical Center from January 2018 to December 2022. Demographic characteristics, presenting symptoms, endocrine profiles, perioperative complications, mortality, length of hospital stay, and discharge outcomes were reviewed. Comparative analyses between surgical groups were performed using Fisher’s exact test and Mann-Whitney U test, with statistical significance set at p < 0.05. Results A total of 67 patients were included, of whom 18 (26.9%) underwent open surgery, and 49 (73.1%) underwent endoscopic surgery. Patients who underwent open surgery were older than those managed endoscopically (50.83 ± 11.26 years vs. 46.75 ± 12.11 years). Visual symptoms predominated in both groups, particularly blurring of vision and bitemporal hemianopsia. Non-functioning adenomas represented the majority of tumors in both cohorts (14; 77.8% vs. 40; 81.6%). Mean prolactin levels were markedly higher in the open surgery group (194.38 ± 633.28 ng/mL vs. 54.62 ± 103.17 ng/mL). The endoscopic cohort demonstrated a shorter mean hospital stay (21.41 ± 15.87 days vs. 23.67 ± 17.62 days), although the difference was not statistically significant (p = 0.512). Diabetes insipidus was the most common postoperative complication in both groups, occurring more frequently following open surgery (n = 5; 27.8% vs. n = 8; 16.3%). Cerebrospinal fluid rhinorrhea occurred exclusively in the endoscopic cohort (n = 3; 6.1%), whereas anemia and cavernous sinus injury were observed only in the open surgery group. Mortality rates were higher in the open surgery cohort (n = 2; 11.1% vs. n = 2; 4.1%), although no statistically significant differences were identified in complication rates, mortality, or discharge disposition between approaches. Most patients demonstrated postoperative improvement or recovery, particularly in the endoscopic cohort (n = 45; 91.8%). Conclusions Both open and endoscopic surgical approaches demonstrated favorable clinical outcomes in the management of pituitary adenomas. Endoscopic surgery was associated with shorter hospitalization and high postoperative recovery rates, supporting its role as the preferred minimally invasive approach for appropriately selected patients, while open surgery remained essential for complex lesions. These findings highlight that safe and effective pituitary surgery can be achieved in a tertiary government hospital within a resource-limited setting.