Recurrent Pituitary Adenomas and Choice of Surgical Procedure: Case Report

Introduction: Pituitary adenomas often regrow. In cases of recurrent surgery, a neurosurgeon faces the dilemma of which approach to choose-microsurgical transseptal, purely endoscopic, or transcranial?

Methods: Until 2007 in cases of pituitary adenoma recurrence, we performed just transseptal or transcranial approaches (in cases of significant supra- and parasellar growth). From 2007, in seven cases (four patients previously operated by transseptal approach, three by transcranial approach) we used a purely endoscopic approach. In two cases of significant antesellar growth, we performed an approach extension with resection of the planum sphenoidale. In two other cases with parasellar tumor growth we experienced technical difficulties with removal of the lateral tumor part, even with the use of an angled endoscope.

Results: From seven patients, total tumor removal was achieved in four cases, subtotal removal (more than 70% of tumor volume) in two cases, and partial removal (less than 70% of tumor volume) in one case.

Conclusion: The purely endoscopic approach reduces traumatic injuries of surgery of the nasal septum and nasal mucosa compared with recurrent transseptal surgeries. The removal of infrasellar and suprasellar parts of a tumor doesn't cause difficulties even in cases of tough tissue tumors. However, the purely endoscopic approach in our practice often doesn't allow the possibility of total tumor removal on the lateral sides.