33 Endoscopic Transsphenoidal Surgery for Pituitary Tumors: Experience and Outcome Analysis from a Tertiary Care Center Nepal

Abstract Introduction Pituitary tumors account for 10–15% of brain tumors and frequently cause morbidity through mass effect or hormonal dysfunction. Endoscopic transsphenoidal surgery (ETS) has become the global standard due to superior visualization and reduced risk compared to microscopic techniques. In Nepal, delayed patient presentation and constrained resources limit the widespread adoption of endoscopic surgery. With limited local outcome data, our study provides benchmark evidence to guide practice in resource‑limited settings Method We conducted a retrospective study of 97 patients who underwent endoscopic pituitary surgery at Tribhuvan University Teaching Hospital, Nepal, between 2018 and 2023. Demographic, radiological, operative, and postoperative variables were analyzed. Results Mean age was 44.4 years (range 17–83), with near‑equal sex distribution. 72.2% cases present with Macroadenomas, with suprasellar extension in 73.2%. Nonfunctioning tumors comprised 64.9% of the cases. Headache was the most frequent symptom, reported in 83.5%, and visual impairment was present in 77.3%, with 6.2% of cases presenting with no perception of light preoperatively. Postoperative vision improvement was seen in 61.9% of cases. Gross or near‑total excision was achieved in 88.7% of cases. Postoperative endocrine assessment demonstrated significant improvement. CSF leak occurred in 10.3% of patients; the majority of the patients were managed successfully with lumbar drainage. Endocrine complications included diabetes insipidus (29.9%) and SIADH (4.1%). The mean hospital stay was 11.4 days. The majority of cases demonstrated excellent functional outcomes in the modified Rankin Scale (mRS), with no perioperative mortality. Conclusions Despite complex tumor morphology and high baseline visual impairment, endoscopic pituitary surgery in Nepal achieved outcomes comparable to global standards. These findings establish benchmark data for neurosurgical practice in low‑ and middle‑income countries, demonstrating feasibility and safety in resource‑limited environments.