Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Feasibility of Endoscopic Endonasal Approach for Recurrent Pituitary Adenomas after Microscopic Trans-Sphenoidal Approach

  • Hwang, Joo Min (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Yong Hwy (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Jin Wook (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Dong Gyu (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Jung, Hee-Won (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Chung, Young Seob (Department of Neurosurgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine)
  • Received : 2013.08.02
  • Accepted : 2013.10.16
  • Published : 2013.10.28
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Abstract

Objective : The surgical approach for recurrent pituitary adenoma after trans-sphenoidal approach (TSA) is challenging. We report the outcomes of the endoscopic TSA for recurrent pituitary adenoma after microscopic TSA. Methods : From February 2010 to February 2013, endoscopic TSA was performed for removal of 30 recurrent pituitary adenomas after microscopic TSA. Twenty-seven (90%) patients had a clinically non-functioning pituitary adenoma. Twenty-four (80%) patients suffered from a visual disturbance related to tumor growth. The clinical features and surgical outcomes were retrospectively analyzed for the ophthalmological, endocrinological, and oncological aspects. Results : The mean tumor volume was 11.7 $cm^3$, and gross total resection was achieved in 50% of patients. The volumetric analysis based on the postoperative MR showed that the mean extent of resection rates were 90%. Vision was improved in 19 (79%) of 24 patients with visual symptoms, and endocrinological cure was achieved in all of three functioning pituitary adenomas; however, the post-operative follow-up endocrinological examination revealed a new endocrinological deficit in one patient. Two patients required antibiotics management for post-operative meningitis. Conclusion : The endoscopic TSA can be an effective treatment option for recurrent pituitary adenoma after microscopic TSA with acceptable outcome.

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References

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