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Objective This study was aimed to compare comparative efficacy of transsphenoidal endonasal endoscopic and microscopic pituitary surgery at single center of a developing country. Methods This study included 198 patients in which 50 patients were studied prospectively and 148 patients were studied retrospectively, diagnosed with pituitary adenoma who presented to neurosurgery department at Sawai Man Singh hospital in Jaipur, India, and were operated via transsphenoidal route between 2013 and 2018. Patients' records were reviewed and relevant clinical and surgical data were collected. Patients were divided into two groups based on the surgical procedure performed, endoscopic endonasal transsphenoid approach (group 1) and microscopic transsphenoidal approach (group 2). Outcomes, in terms of efficacy and the resulting complications of each procedure were compared and analyzed. Results A total of 198 patients with pituitary adenoma were operated during the study period. Among them, 119 (60.1%) patients were operated by endoscopic and 79 (39.9%) patients were operated by microscopic transsphenoidal approach. In endoscopic group, intraoperative cerebrospinal fluid (CSF) leak was present in 39 patients (32.77%) and 23 (29.11%) in microscopic group. Complete tumor removal was achieved in 69.75% in endoscopic and 48.13% in microscopic group ( p = 0.004). Endocrine control was achieved in 78.94% (30 out of 38) in endoscopic and 68.18% (15 out of 22 patients) in microscopic group. Conclusion The transsphenoidal approaches for resection of pituitary adenoma, both endoscopic and microscopic approach, are minimally invasive and effective for disease control. Both the approaches lead to similar endocrine control, visual symptoms, complications, and long-term outcome. Therefore, the selection of the final approach should be individualized, ultimately depending on the surgeons' comfort, experience, and familiarity with the particular technique.
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OBJECTIVE: Pseudoaneurysms (PSAs) of the internal carotid artery (ICA) and vertebral artery are rare entities but with varied treatment options. PSAs can be spontaneous or secondary to trauma, infections, malignancies or iatrogenic. To find out the efficacy of various endovascular interventions in the management of ICA and vertebral PSAs. METHODS: The study included 14 patients diagnosed with intracranial PSAs who underwent endovascular interventions in SMS Medical College, Jaipur (Rajasthan) between June 2015 to January 2019. The clinical and radiological findings (computed tomography angiography and digital subtraction angiography) were reviewed and the consequent endovascular intervention carried out and their results were analyzed. RESULTS: Total 14 patients were studied out of which 8 (57.1%) were anterior circulation PSAs and 6 (42.9%) were posterior circulation PSAs There were 10 (71.4%) females and 4 (28.5%) males between the age of 9 to 65 years. Only 2 patients with PSA had past history of trauma. Coiling was done in 8 patients (57.1%), stenting in 2 patients (14.2%), parent artery occlusion in 1 patient (7.1%), glue embolization in 1 patient (7.1%) while coiling with glue in 1 patient (7.1%) and flow diverter in 2 patients (14.2%). Immediate and complete occlusion was achieved in 11 (78.6%) patients while 3 (21.4%) patients had subtotal occlusion. 11 patients under follow up till June 2019 did not report recurrence or new neurological deficit. CONCLUSIONS: Endovascular interventions is minimally invasive and safe treatment strategy for intracranial PSAs. The ultimate choice of technique depends on clinical and imaging characteristics.