title: Repeated transsphenoidal surgery for resection of pituitary adenoma.
abstract: To investigate the surgical strategy of repeated microscopic transsphenoidal surgery (TSS) for treatment of pituitary adenoma, surgical techniques and treatment outcomes for 29 patients with pituitary adenoma were reviewed and analyzed. There were 17 patients who underwent TSS 18 times and 12 patients who underwent TSS 13 times. The interval between each TSS ranged from 3 months to 18 years, with a median time of 4 years. The tumor height was 15 to 45 mm on the last surgery. Among the 29 patients, 16 patients underwent total tumor resection, 11 patients underwent subtotal resection, and 2 patients underwent partial resection. Cerebrospinal fluid leak occurred in 10 patients. Among 24 patients who were followed up effectively, 1 patient developed abducens paralysis after surgery, 1 patient had chronic diabetes insipidus, and 1 patient received steroid-dependent alternative treatment. The repeated TSS may present satisfied outcomes in experienced hands. The upper edge of the posterior choanae should be identified to ensure the right orientation. The openings of the anterior wall of the sphenoid sinus and the sellar floor should be appropriately expanded to improve tumor exposure. The artificial materials should be identified and removed carefully. Intraoperative cerebrospinal fluid leakage should be managed well.
authors: From the Department of Neurosurgery, Fuzhou General Hospital, Fujian Medical University, Fuzhou, People's Republic of China.
authors: Shousen
authors: S
authors: Wang
authors: Deyong
authors: D
authors: Xiao
authors: Rumi
authors: R
authors: Wang
authors: Liangfeng
authors: L
authors: Wei
authors: Jingfang
authors: J
authors: Hong
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000627:therapeutic use; D065634:Cerebrospinal Fluid Leak / Q000517:prevention & control; D003919:Diabetes Insipidus / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery; D009300:Nasal Septum / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D018365:Neoplasm, Residual / Q000601:surgery; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000473:pathology / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials; D014014:Tissue Adhesives