Surgical Outcomes Following Repeat Transsphenoidal Surgery for Nonfunctional Pituitary Adenomas: A Retrospective Comparative Study

Oper Neurosurg (Hagerstown). 2019 Feb 1;16(2):127-135. doi: 10.1093/ons/opy078.


Background: Endonasal transsphenoidal surgery (ETSS) remains the preferred treatment for recurrent or residual nonfunctional pituitary adenomas (NFPAs). However, surgical complications and outcomes with repeat ETSS are unclear.

Objective: To compare outcomes from primary and repeat ETSS in patients with NFPAs.

Methods: Retrospective review of ETSS for NFPAs at USC University Hospital and LAC + USC Medical Center between 2000 and 2015. Patients with ≥3-mo follow-up data were included. Patients were categorized as primary or repeat ETSS. Patient and tumor characteristics were compared preoperatively, and postoperative outcomes were analyzed.

Results: Two hundred sixty-eight patients (89%) met the inclusion criteria (primary ETSS = 211 and repeat ETSS = 57) with a mean follow-up time of 38 mo (range 3-235 mo). Both groups had similar demographics, endocrine function, and tumor characteristics. Surgical complication rates were similar and no mortalities were observed. Repeat ETSS patients had a higher rate of new postoperative panhypopituitarism (primary ETSS: 0.5% vs repeat ETSS: 7.1%, P = .011), lower rates of gross total resection (GTR; primary ETSS: 59.2% vs repeat ETSS: 26.3%, P = .001), and greater rates of postoperative radiosurgery (36.8% vs 24.2%, P = .009). At 2-yr follow-up, progression-free survival on MRI was similar in both groups (primary ETSS: 97.9% vs repeat ETSS: 95.4%, log-rank test P = .807).

Conclusion: At experienced tertiary pituitary centers, repeat ETSS for NFPAs was associated with a similar incidence of surgical complications as primary ETSS. However, repeat ETSS carried a higher rate for worsening endocrine dysfunction and a lower rate of GTR.

Publication types

  • Comparative Study

MeSH terms

  • Adenoma / complications
  • Adenoma / surgery*
  • Adult
  • Aged
  • Female
  • Humans
  • Hypopituitarism / etiology
  • Male
  • Middle Aged
  • Nasal Cavity
  • Natural Orifice Endoscopic Surgery
  • Neoplasm Recurrence, Local / complications
  • Neoplasm Recurrence, Local / surgery*
  • Neoplasm, Residual
  • Neuroendoscopy / methods*
  • Pituitary Neoplasms / complications
  • Pituitary Neoplasms / surgery*
  • Postoperative Complications / epidemiology*
  • Reoperation
  • Retrospective Studies
  • Sphenoid Sinus*
  • Treatment Outcome
  • Vision Disorders / etiology