title: Extent of Resection, Visual, and Endocrinologic Outcomes for Endoscopic Endonasal Surgery for Recurrent Pituitary Adenomas.
abstract: OBJECTIVE
  To assess outcomes after endoscopic endonasal surgery for recurrent or residual pituitary adenomas.
  
  
  METHODS
  We retrospectively analyzed 61 patients from 2009 to 2016 who underwent endoscopic endonasal surgery for recurrent or residual pituitary adenomas after previous microscopic or endoscopic transsphenoidal operation.
  
  
  RESULTS
  The previous surgical approach was endoscopic endonasal in 55.7% and microscopic in 44.2% of patients. The mean preoperative maximal tumor diameter was 2.3 cm. Tumor commonly invaded the suprasellar cistern (63.9%). Gross total resection (GTR) was achieved in 31 patients (51.7%). GTR rate was 68.4% and 21.7% for Knosp grade 0-2 and grade 3-4 tumors, respectively (P < 0.001). GTR was 73.1% and 35.3% for patients with previous microscopic and endoscopic transsphenoidal surgery, respectively (P = 0.002). On multivariate analysis, smaller tumor size (odds ratio [OR], 1.1 per cm; P = 0.007), Knosp grade 0-2 (OR, 9.7; P = 0.002), and previous microscopic approach (OR, 12.7; P = 0.007) were independent predictors of GTR. Preoperative visual deficit outcome was improved in 32.5%, unchanged in 62.5%, and worse in 5.0%. New postoperative endocrinopathies included adrenal insufficiency (6.5%), hypothyroidism (8.1%), hypogonadism (6.5%), and diabetes insipidus (4.9%). Complications included postoperative cerebrospinal fluid leak (4.9%), meningitis (1.6%), medical complications (4.9%), and postoperative hematoma requiring re-exploration (3.2%).
  
  
  CONCLUSIONS
  The endoscopic endonasal approach provides a safe and effective option for recurrent pituitary adenomas. Smaller tumor size, absence of cavernous sinus invasion, and previous microscopic approach were independent predictors of GTR. This finding might suggest that inadequate exposure or limited viewing angle may adversely affect extent of resection in primary microscopic surgeries.
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Hyunwoo
authors.initials: H
authors.lastname: Do
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA; Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Varun R
authors.initials: VR
authors.lastname: Kshettry
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Siu
authors.affiliation: Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Department of Ophthalmology, NYU Langone Medical Center, New York, New York, USA.
authors.forename: Irina
authors.initials: I
authors.lastname: Belinsky
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Farrell
authors.affiliation: Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Gurston
authors.initials: G
authors.lastname: Nyquist
authors.affiliation: Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Rosen
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA; Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. Electronic address: james.evans@jefferson.edu.
authors.forename: James J
authors.initials: JJ
authors.lastname: Evans
mesh_terms: D000236:Adenoma / Q000150:complications / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004703:Endocrine System / Q000502:physiology*; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009666:Nose / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
keywords: Endocrine; Resection; Revision; Transnasal; Transsphenoidal; Vision