J Neurol Surg B Skull Base 2015; 76(01): 050-056
DOI: 10.1055/s-0034-1383856
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Endonasal Surgery for Recurrent Pituitary Tumors: Technical Challenges to the Surgical Approach

Bobby A. Tajudeen
1   Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
,
Jagmeet Mundi
1   Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
,
Jeffrey D. Suh
1   Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
,
Marvin Bergsneider
2   Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
,
Marilene B. Wang
1   Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
› Author Affiliations
Further Information

Publication History

22 September 2014

06 May 2014

Publication Date:
13 September 2014 (online)

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.

Notes

Presented at the Annual Meeting of the North American Skull Base Society; February 18–20, 2011; Phoenix, AZ.


 
  • References

  • 1 Rudnik A, Zawadzki T, Gałuszka-Ignasiak B , et al. Endoscopic transsphenoidal treatment in recurrent and residual pituitary adenomas—first experience. Minim Invasive Neurosurg 2006; 49 (1) 10-14
  • 2 Tabaee A, Anand VK, Barrón Y , et al. Endoscopic pituitary surgery: a systematic review and meta-analysis. J Neurosurg 2009; 111 (3) 545-554
  • 3 Hornyak M, Couldwell WT. Multimodality treatment for invasive pituitary adenomas. Postgrad Med 2009; 121 (2) 168-176
  • 4 Melmed S. Update in pituitary disease. J Clin Endocrinol Metab 2008; 93 (2) 331-338
  • 5 Cushing H. Intracranial tumors: notes upon a series of two-thousand verified cases with surgical-mortality percentages pertaining thereto. JAMA 1933; 100 (4) 284
  • 6 Cohen-Gadol AA, Laws ER, Spencer DD, De Salles AA. The evolution of Harvey Cushing's surgical approach to pituitary tumors from transsphenoidal to transfrontal. J Neurosurg 2005; 103 (2) 372-377
  • 7 Hardy J, Wigser SM. Trans-sphenoidal surgery of pituitary fossa tumors with televised radiofluoroscopic control. J Neurosurg 1965; 23 (6) 612-619
  • 8 Jho HD, Carrau RL. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 1997; 87 (1) 44-51
  • 9 Ciccarelli E, Ghigo E, Miola C, Gandini G, Muller EE, Camanni F. Long-term follow-up of 'cured' prolactinoma patients after successful adenomectomy. Clin Endocrinol (Oxf) 1990; 32 (5) 583-592
  • 10 Abosch A, Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB. Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: initial outcome and long-term results. J Clin Endocrinol Metab 1998; 83 (10) 3411-3418
  • 11 Cappabianca P, Alfieri A, Colao A , et al. Endoscopic endonasal transsphenoidal surgery in recurrent and residual pituitary adenomas: technical note. Minim Invasive Neurosurg 2000; 43 (1) 38-43
  • 12 Long H, Beauregard H, Somma M, Comtois R, Serri O, Hardy J. Surgical outcome after repeated transsphenoidal surgery in acromegaly. J Neurosurg 1996; 85 (2) 239-247
  • 13 Abe T, Lüdecke DK. Recent results of secondary transnasal surgery for residual or recurring acromegaly. Neurosurgery 1998; 42 (5) 1013-1021 ; discussion 1021–1022
  • 14 Barkan AL. Acromegaly. Trends Endocrinol Metab 1992; 3 (6) 205-210
  • 15 Giovanelli M, Losa M, Moritini P, Acromegaly: surgical results and prognosis. . In: Landolt AM, Vance L, Reilly PL. , eds. Pituitary Adenomas. New York, NY: Churchill Livingstone; 1996: 333-351
  • 16 Paluzzi A, Fernandez-Miranda JC, Tonya Stefko S, Challinor S, Snyderman CH, Gardner PA. Endoscopic endonasal approach for pituitary adenomas: a series of 555 patients. Pituitary 2013; August 2 ( Epub ahead of print)
  • 17 McLaughlin N, Eisenberg AA, Cohan P, Chaloner CB, Kelly DF. Value of endoscopy for maximizing tumor removal in endonasal transsphenoidal pituitary adenoma surgery. J Neurosurg 2013; 118 (3) 613-620