Repeated transsphenoidal surgery to treat recurrent or residual pituitary adenoma.
OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
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.
Benveniste
Ronald J
RJ
Department of Neurosurgery, Mt. Sinai School of Medicine, New York, New York 10029, USA.
King
Wesley A
WA
Walsh
Jane
J
Lee
Jacob S
JS
Delman
Bradley N
BN
Post
Kalmon D
KD
D000236:Adenoma / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001971:Bromocriptine / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D018365:Neoplasm, Residual / Q000401:mortality / Q000601:surgery*; D019635:Neurosurgical Procedures; D047748:Pituitary ACTH Hypersecretion / Q000401:mortality / Q000601:surgery; D010911:Pituitary Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011237:Predictive Value of Tests; D011878:Radiotherapy; D012086:Reoperation; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000601:surgery*; D016896:Treatment Outcome
D006727:Hormone Antagonists; D001971:Bromocriptine