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Endoscopic Endonasal Transsphenoidal Surgery in Recurrent and Residual Pituitary Adenomas: Technical Note1
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2000
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Surgical OncologyTumour ExcisionRecurrence RatePituitary GlandResidual Pituitary AdenomasEndocrine SurgeryEndonasal SurgerySurgeryPituitary DiseaseSkull Base SurgeryTechnical Note1Recurrent Pituitary AdenomasMedicineRadiologySkull Base
Pituitary adenomas have a high recurrence rate after surgery, and treatment decisions are complicated by lesion characteristics, anatomy, and multiple therapeutic options, but the minimally invasive endoscopic endonasal transsphenoidal approach offers faster, safer, and more extensive tumor excision. The study aims to evaluate the endoscopic endonasal transsphenoidal approach for pituitary surgery at the University of Naples. The authors assessed the technique in 12 recurrent pituitary adenoma patients and 2 craniopharyngioma patients previously treated with transnasal transsphenoidal surgery, where prior surgery or radiation had distorted anatomy. The authors conclude that endoscopic transsphenoidal re‑operation is a preferred option for recurrent tumors, offering ease that may encourage its broader use before more aggressive therapies.
Despite a good cure rate after surgery, the recurrence rate in pituitary adenomas is globally high. The decision making in such cases can be problematic for the nature of the lesion, for the anatomic structures involved, for the different pharmacological, surgical, radiotherapeutic and radiosurgical options nowadays available. In the perspective of an improvement and refinement of the surgical procedure an endoscopic endonasal transsphenoidal approach to the pituitary was recently adopted in the Neurosurgical Department of the University of Naples. Its minimal invasiveness and its wider and direct anatomic control of the operative field has allowed a faster, greater and safer potential of tumour excision, with respect of the sphenoid, sellar and parasellar structures. The authors have examined the advantages provided by this technique in 12 patients with recurrent pituitary adenomas and in 2 craniopharyngiomas already treated via a transnasal transsphenoidal approach (TTA), where the anatomy of surgical field had been distorted by the first operation or the radiation therapy. They conclude that the endoscopic transsphenoidal re-operation might be considered the procedure of choice in case of recurrences and its easiness in such conditions could favour its larger use, before other more aggressive therapeutic solutions.