Efficacy of microsurgical sublabial approach (MSA) versus endoscopic endonasal approach (EEA) for the treatment of pituitary adenomas based on radiological and hormonal outcome

Background The purpose of this study was to compare the surgical efficacy of the microsurgical sublabial approach (MSA) versus the endoscopic endonasal approach (EEA) for the treatment of pituitary adenomas, based on short-term (12 months) radiological and endocrinological follow-up. Methods One hundred and fourteen patients affected by pituitary adenoma were enrolled at our Unit between January 2007 and February 2012; 72 were treated with MSA, and 42 with EEA. The preoperative parameters considered were: type of lesion (secreting or nonsecreting), lesion size, presence of intralesional hemorrhage, lesion perimeter (nodular vs. uniform), intrasellar vs. suprasellar, involvement of cavernous sinus, and osteodural infiltration. Hormonal assays and magnetic resonance imaging (MRI) scans were performed at 12 months after the surgical procedure. Results Univariate analysis of the data documented a statistically significant difference in favor of MSA for the subgroups of secreting adenomas (90.9% vs. nonsecreting 48.3%), micro- adenomas (100% vs. macroadenomas 57.1%), adenomas without osteodural infiltration (87.5% vs. 55.5% with the infiltration) or those without intralesional hemorrhage (75% vs. 45.9% with the hemorrhage), and growth hormone (GH) adenomas (88.8% vs. 43.7%). Multivariate analysis confirmed the greater effectiveness of MSA for the treatment of micro-secreting adenomas. Conclusions Recent advances in the EEA for treating pituitary adenomas could lead to this modality replacing the microsurgical technique. In our experience the MSA allowed us to achieve better results in the treatment of microadenomas.