Endonasal transsphenoidal re-excision of recurrent or residual pituitary adenomas after transseptal microsurgery

Objective:To evaluate the effect of endonasal transsphenoidal re-excision of recurrent or residual pituitary adenomas after transseptal microsurgery.Methods:Thirty-two patients suffering from recurrent or residual pituitary adenomas after transseptal microsurgery were re-operated on by endonasal transsphenoidal surgery from October,2001 to October,2005.Results:Gross removal of tumors in 14 cases(43.8%) and subtotal removal in 10 cases(31.2%) were achieved.Partial removal was carried out in the remaining 8 cases(25%).No death was happened postoperatively.Among the 13 patients with hormone-secreting adenomas,6 cases got normal hormone levels,7 cases improved clinically with decreased serum hormone levels.Six to forty eight months[KG-*2/8]'follow-ups in 24 patients(75%) revealed that the post-/pre-operative improvements were as follows: diminished acuity and visual field defects,21/22;headache,8/9;acromegaly,5/7;galactorrhea and amenorrhea,3/4.Conclusion:Endonasal transsphenoidal re-excision of recurrent or residual pituitary adenomas after transseptal surgery can make maximal use of the natural space of nasal cavity,which has many advantages such as direct approach,minimal invasion,and less postoperative complications.It is the best approach for treating recurrent or residual pituitary adenomas in spite of some degrees of operative difficulties.