Long term outcome following repeat transsphenoidal surgery for recurrent endocrine-inactive pituitary adenomas |
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Authors: | Edward F Chang Michael E Sughrue Gabriel Zada Charles B Wilson Jr" target="_blank">Lewis S BlevinsJr Sandeep Kunwar |
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Institution: | (1) Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA, USA;(2) Department of Neurological Surgery, University of Southern California, Los Angeles, CA, USA; |
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Abstract: | It is widely accepted that the standard first-line treatment for most endocrine inactive pituitary macroadenomas (EIA) is
surgery, usually via a transsphenoidal approach. What is less clear is what approach to take when these tumors recur, especially
when this recurrence involves areas which are difficult to surgically remove tumor from, such as the suprasellar region or
cavernous sinuses. We present long term follow-up for a series of 81 patients who underwent repeat surgery for recurrent non-secreting
pituitary adenomas. We analyzed data collected from all adult patients undergoing their second microsurgical transsphenoidal
resection of a histologically proven endocrine-inactive pituitary adenoma at the University of California at San Francisco
between January 1970 and March 2001. Data for these patients were collected by review of medical records, mail, and/or telephone
interviews. Visual function, anterior pituitary function, and tumor control rates were analyzed for the series. Records were
available for a total of 81 recurrent EIA patients. The median time between their initial and repeat operations was 4.1 years.
The mean tumor size was 2.2 ± 0.2 cm. A total of 35/81 patients had greater than 5 years of follow-up. A total of 24/81 patients
had greater than 10 years of follow-up. Over one half of these patients presented with visual disturbance, and we found that
39% of these patients experienced improved vision with a second surgery. More importantly, no one with normal vision suffered
any appreciable decline in vision. Approximately, 35% of patients with pre-operative anterior pituitary dysfunction recovered
function after surgery in our series; and no patient’s function worsened. A total of 4/52 (8%) patients with greater than
2 years of post-op follow-up experienced a clinically meaningful tumor recurrence requiring additional treatment. Our data
suggest that when performed by experienced transsphenoidal surgeons, durable tumor control can be obtained in these frequently
locally aggressive tumors with acceptable rates of post-operative morbidity. |
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