title: Endoscopic endonasal surgery for recurrent pituitary tumors: technical challenges to the surgical approach.
abstract: Objective To review our experience in a series of patients who underwent revision endoscopic pituitary surgery. Methods Retrospective chart review. Results A total of 27 patients were included in the study. Of the 21 patients who required nasoseptal flap reconstruction, a left-sided nasoseptal flap was successfully used in 13 patients. Gross total or near-total resection of tumor was achieved in 74.1%. Cavernous sinus invasion and presentation with residual disease were identified as factors limiting extent of resection (p = 0.002 and 0.009, respectively). A statistically significant difference (p = 0.027) was noted between mean largest tumor dimension in patients with gross total resection and those with near-total or subtotal resection. Complications occurred in 22% and included postoperative temporary diabetes insipidus (n = 2), postoperative hypotension (n = 2), new anterior pituitary insufficiency (n = 1), and right-sided abducens palsy (n = 1). Conclusions Revision endoscopic pituitary surgery is advantageous but technically challenging. Cavernous sinus invasion and presentation with residual disease were significant factors limiting extent of resection. Suprasellar extension was not a factor limiting extent of resection and may prove to be an advantage over microscopic speculum-based approaches. Because of the right-sided scarring from prior surgery, a left-sided nasoseptal flap is reliable and advantageous.
authors: Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States.
authors: Bobby A
authors: BA
authors: Tajudeen
authors: Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States.
authors: Jagmeet
authors: J
authors: Mundi
authors: Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States.
authors: Jeffrey D
authors: JD
authors: Suh
authors: Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States.
authors: Marvin
authors: M
authors: Bergsneider
authors: Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States.
authors: Marilene B
authors: MB
authors: Wang