Report of Endoscopic Endonasal Surgery in Recurrent Pituitary Adenomas After Microscopic Resection

Object: The effectiveness of endoscopic endonasal surgery in recurrent pituitary adenomas after initial microscopic resection is evaluated.

Methods: We conducted a retrospective review of patients who underwent a purely endoscopic resection of recurrent pituitary adenomas after previous microscopic surgery. Clinical and radiological data, degree of previous surgical exploration, and pathology reports were reviewed. Comparison was made to other series of endoscopic and microscopic transsphenoidal surgery for recurrent adenomas.

Results: Twenty patients were included. Mean follow-up period was 25 months. Fourteen tumors were nonfunctional adenomas. In 10 cases (50%), the tumor invaded the cavernous sinus, precluding total resection. Total removal was achieved in 8 cases (40%). Five patients required additional therapy during the follow-up period. Of 6 patients who had preoperative visual deficit, 3 improved and the other 3 remained stable. No patient developed new endocrine or cranial nerve deficit. The previous sphenoidotomy and the sellar opening were felt to be significantly limited in12 (60%) and 10 cases (50%), respectively. In 6 out of 8 patients with gross total resection, the previous exposure was significantly limited. The sellar opening was limited in the lateral direction, whereas the sphenoidotomy limitation was in the lateral and craniocaudal direction. Complication rate was low.

Conclusion: The limited exposure by microscopic transsphenoidal surgery might be an explanation for incomplete adenoma resection. The endoscopic endonasal approach offers a better panoramic exposure. The very good outcome in this setting makes the endoscopic approach a valid option in the treatment of recurrent pituitary adenomas treated initially by microscopic transsphenoidal surgery.