Repeated transsphenoidal surgery to treat recurrent or residual pituitary adenoma
- 1 June 2005
- journal article
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery
- Vol. 102 (6), 1004-1012
- https://doi.org/10.3171/jns.2005.102.6.1004
Abstract
In this paper the authors describe the indications for and the results and complications of repeated transsphenoidal surgery (RTSS) to treat recurrent or residual pituitary adenoma. A retrospective review was conducted of 96 consecutive patients who underwent RTSS to treat recurrent or residual pituitary adenoma. Ninety-six patients underwent RTSS: 42 to treat a recurrent or residual pituitary mass and 54 to treat a recurrent or persistent hormone hypersecretion. There was no case of perioperative death and there was a 1% incidence of major complications. Postoperative endocrinological deficiencies were uncommon unless planned total hypophysectomy was performed to treat Cushing disease. Clinical remission occurred in 93% of patients undergoing RTSS to treat a tumor mass, and 15% of patients initially experienced remission only to face a relapse after a mean of 32 months. Endocrinological remission occurred in 57% of patients undergoing RTSS to treat hormone hypersecretion; most of these patients had Cushing disease. Thirty-five percent of patients with an initial endocrinological remission experienced a relapse of their symptoms after a mean of 31 months (thus, 37% of patients achieved sustained endocrinological remission). We failed to identify factors that accurately predicted initial symptom remission or delayed relapse following RTSS. Ten patients in our series eventually underwent a third transsphenoidal surgery without major complications. Repeated transsphenoidal surgery is a more effective treatment for recurrent or residual mass than it is for hormone hypersecretion and has acceptable rates of morbidity and mortality. If hypophysectomy is not performed, endocrinological deficiencies are unlikely following RTSS.Keywords
This publication has 31 references indexed in Scilit:
- Gamma knife surgery for treatment of residual nonfunctioning pituitary adenomas after surgical debulkingJournal of Neurosurgery, 2004
- LINAC Radiosurgery in Recurrent Cushing's Disease after Transsphenoidal Surgery: A Series of 5 Casesmin - Minimally Invasive Neurosurgery, 2003
- Radiosurgery for non—small cell lung carcinoma metastatic to the brain: long-term outcomes and prognostic factors influencing patient survival time and local tumor controlJournal of Neurosurgery, 2002
- Repeated gamma knife surgery for multiple brain metastases from renal cell carcinomaJournal of Neurosurgery, 2002
- Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas: factors associated with endocrine normalizationJournal of Neurosurgery, 2002
- Pituitary Surgery: Transsphenoidal ApproachNeurosurgery, 2002
- Delayed Epistaxis Resulting from External Carotid Artery Injury Requiring Embolization: A Rare Complication of Transsphenoidal Surgery: Case ReportNeurosurgery, 2000
- Surgical outcome after repeated transsphenoidal surgery in acromegalyJournal of Neurosurgery, 1996
- Early repeat surgery for persistent Cushing's diseaseJournal of Neurosurgery, 1994
- Transsphenoidal surgery following unsuccessful prior therapyJournal of Neurosurgery, 1985