title: Feasibility of endoscopic endonasal approach for recurrent pituitary adenomas after microscopic trans-sphenoidal approach.
abstract: OBJECTIVE
  The surgical approach for recurrent pituitary adenoma after trans-sphenoidal approach (TSA) is challenging. We report the outcomes of the endoscopic TSA for recurrent pituitary adenoma after microscopic TSA.
  
  
  METHODS
  From February 2010 to February 2013, endoscopic TSA was performed for removal of 30 recurrent pituitary adenomas after microscopic TSA. Twenty-seven (90%) patients had a clinically non-functioning pituitary adenoma. Twenty-four (80%) patients suffered from a visual disturbance related to tumor growth. The clinical features and surgical outcomes were retrospectively analyzed for the ophthalmological, endocrinological, and oncological aspects.
  
  
  RESULTS
  The mean tumor volume was 11.7 cm(3), and gross total resection was achieved in 50% of patients. The volumetric analysis based on the postoperative MR showed that the mean extent of resection rates were 90%. Vision was improved in 19 (79%) of 24 patients with visual symptoms, and endocrinological cure was achieved in all of three functioning pituitary adenomas; however, the post-operative follow-up endocrinological examination revealed a new endocrinological deficit in one patient. Two patients required antibiotics management for post-operative meningitis.
  
  
  CONCLUSIONS
  The endoscopic TSA can be an effective treatment option for recurrent pituitary adenoma after microscopic TSA with acceptable outcome.
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Joo Min
authors.initials: JM
authors.lastname: Hwang
authors.forename: Yong Hwy
authors.initials: YH
authors.lastname: Kim
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Kim
authors.forename: Dong Gyu
authors.initials: DG
authors.lastname: Kim
authors.forename: Hee-Won
authors.initials: HW
authors.lastname: Jung
authors.forename: Young Seob
authors.initials: YS
authors.lastname: Chung
keywords: Endoscopy; Pituitary adenoma; Revision surgery