title: Results and risk factors for recurrence following endoscopic endonasal transsphenoidal surgery for pituitary adenoma.
abstract: BACKGROUND
  Endoscopic endonasal (EE) transsphenoidal surgery is an important surgical approach to the treatment of sellar pathology, particularly for pituitary adenomas. Risk factors for the radiographic recurrence of pituitary adenomas resected using a purely endoscopic approach have not been established. This study investigates outcomes and identifies risk factors for recurrence following EE transsphenoidal surgery for pituitary adenoma.
  
  
  METHODS
  We performed a retrospective review of 64 patients with pituitary adenomas undergoing EE surgery by a single, right-handed surgeon preferentially operating through the right nares. Post-operative MRI studies were utilized to monitor for residual disease or disease recurrence.
  
  
  RESULTS
  Residual tumor was found in 31.2% of patients. Over a median follow-up period of 23.1 months (range 4-62.5), 4 (20%) of these patients showed recurrence. Two patients with inconclusive post-operative imaging had subsequent imaging consistent with recurrence, making the total recurrence in our series 9.4%. While no statistically significant effects of gender, age or history of previous treatment were seen, amenorrhea on presentation and maximum tumor diameter >10 mm were significant risk factors for radiographic recurrence (p = 0.044 and 0.005, respectively). No predominant side of residual tissue was identified in these tumors operated through the right nares.
  
  
  CONCLUSIONS
  Only 20% of patients with residual tumor developed recurrent disease over a median follow up of 23.1 months. This recurrence rate may be an important consideration in cases where gross total resection is not feasible. Preferentially operating from the right does not seem to influence the location of residual tumor.
authors.affiliation: Weill Cornell Brain Tumor Center, Department of Neurosurgery, Weill Medical College of Cornell University, New York, USA. Electronic address: imb2004@med.cornell.edu.
authors.forename: Imithri
authors.initials: I
authors.lastname: Bodhinayake
authors.affiliation: Weill Cornell Brain Tumor Center, Department of Neurosurgery, Weill Medical College of Cornell University, New York, USA.
authors.forename: Malte
authors.initials: M
authors.lastname: Ottenhausen
authors.affiliation: Weill Cornell Brain Tumor Center, Department of Neurosurgery, Weill Medical College of Cornell University, New York, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mooney
authors.affiliation: Weill Cornell Brain Tumor Center, Department of Neurosurgery, Weill Medical College of Cornell University, New York, USA.
authors.forename: Kartik
authors.initials: K
authors.lastname: Kesavabhotla
authors.affiliation: Division of Biostatistics and Epidemiology, Department of Public Health, Weill Medical College of Cornell University, New York, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Christos
authors.affiliation: Weill Cornell Brain Tumor Center, Department of Neurosurgery, Weill Medical College of Cornell University, New York, USA.
authors.forename: Justin T
authors.initials: JT
authors.lastname: Schwarz
authors.affiliation: Weill Cornell Brain Tumor Center, Department of Neurosurgery, Weill Medical College of Cornell University, New York, USA. Electronic address: jab2029@med.cornell.edu.
authors.forename: John A
authors.initials: JA
authors.lastname: Boockvar
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D018365:Neoplasm, Residual; D044583:Neuroendoscopy / Q000379:methods*; D010911:Pituitary Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013101:Sphenoid Sinus / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Endoscopic; Pituitary; Recurrence; Risk factors; Transsphenoidal