Assessment of clinical and surgical outcomes of endoscopic endonasal transsphenoidal resection of large pituitary adenomas: a prospective study

Abstract Background Large pituitary adenomas are associated with considerable visual, endocrinological, and neurological morbidity because of their sellar and parasellar extension. Endoscopic endonasal transsphenoidal surgery has become an established minimally invasive approach for their management. This prospective cohort study evaluates the surgical, radiological, and functional outcomes of endoscopic endonasal transsphenoidal resection for large pituitary adenomas. Results The mean tumor size was 3.50 ± 0.23 cm, and visual impairment was the most common presenting symptom (96.7%). Gross total resection was achieved in 50.0% of patients, near-total resection in 30.0%, and subtotal or partial resection in 20.0%. Visual improvement occurred in 83.3% of cases without postoperative visual deterioration. Among patients with functioning adenomas, hormonal improvement occurred in 7/8 cases (87.5%), corresponding to 23.3% of all patients. Perioperative complications occurred in 46.7%, with postoperative cerebrospinal fluid leak being the most frequent complication (23.3%). Tumor morphology and sphenoid sinus extension significantly influenced extent of resection. Conclusions Endoscopic endonasal transsphenoidal surgery achieved effective tumor debulking with favorable visual outcomes and acceptable morbidity. Anatomical tumor characteristics significantly influenced resectability, supporting individualized surgical planning for large pituitary adenomas.