J Neurol Surg B Skull Base 2023; 84(S 01): S1-S344
DOI: 10.1055/s-0043-1762167
Presentation Abstracts
Oral Abstracts

Characteristics and Outcomes of Recurrent Pituitary Adenoma Patients Undergoing Revision Endoscopic Endonasal Surgery

Kevin T. Grafmiller
1   Department of Otolaryngology Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, United States
,
Nikitha Kosaraju
2   University of California, David Geffen School of Medicine, Los Angeles, California, United States
,
Jessa E. Miller
1   Department of Otolaryngology Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, United States
,
Benjamin R. Uy
3   Department of Neurosurgery, University of California, Los Angeles, California, United States
,
Hye Rhyn Chung
2   University of California, David Geffen School of Medicine, Los Angeles, California, United States
,
Ryan M. Shih
2   University of California, David Geffen School of Medicine, Los Angeles, California, United States
,
Myungjun Ko
2   University of California, David Geffen School of Medicine, Los Angeles, California, United States
,
Shannon R. Esswein
2   University of California, David Geffen School of Medicine, Los Angeles, California, United States
,
Arash Abiri
4   University of California, Irvine School of Medicine, Irvine, California, United States
,
Pooya Khosravi
4   University of California, Irvine School of Medicine, Irvine, California, United States
,
Nolan Huck
4   University of California, Irvine School of Medicine, Irvine, California, United States
,
Cecilia H. Nguyen
4   University of California, Irvine School of Medicine, Irvine, California, United States
,
Timothy Hsu
4   University of California, Irvine School of Medicine, Irvine, California, United States
,
Michael G. Kim
5   Department of Neurosurgery, University of California, Irvine, California, United States
,
Frank P. Hsu
5   Department of Neurosurgery, University of California, Irvine, California, United States
,
Won Kim
3   Department of Neurosurgery, University of California, Los Angeles, California, United States
,
Jivianne K. Lee
1   Department of Otolaryngology Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, United States
,
Jeffery D. Suh
1   Department of Otolaryngology Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, United States
,
Marvin Bergsneider
3   Department of Neurosurgery, University of California, Los Angeles, California, United States
,
Edward C. Kuan
6   Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, United States
,
Marilene Wang
1   Department of Otolaryngology Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, United States
› Author Affiliations
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Objective: To describe the characteristics and outcomes of patients undergoing endoscopic endonasal revision surgery for recurrent pituitary adenomas.

Methods: A retrospective chart review was conducted of all pituitary adenoma patients who underwent revision endoscopic endonasal surgery for recurrent tumor from 2008 to 2021 at a single tertiary-care institution.

Results: A total of 94 revision pituitary surgery patients were identified during this time period. The majority of revisions were performed on recurrent, non-functional adenomas (69.1%). Growth hormone (GH) secreting tumors (10.6%) and adrenocorticotrophic hormone (ACTH) secreting tumors (9.6%) were the most common secretory adenomas requiring revision surgery for recurrent tumor. When comparing the current patient cohort to a previous historical cohort of endoscopic endonasal skull base surgery patients, cavernous sinus invasion was present in 72.0% versus 20.0% of the historical cohort, intraoperative cerebrospinal fluid (CSF) leaks occurred in 50.1% versus 30.7%, postoperative CSF leaks occurred in 4.3% versus 2.3%, and gross total resection was achieved in 43.6% versus 80.0% in the historical cohort of patients. Only 12.9% of patients with functional adenomas continued to have post-operative secretory symptoms. Postoperatively 2.2% of patients developed meningitis and 25.8% developed diabetes insipidus, which is similar to rates in the literature for primary pituitary surgery. Mean hospital length of stay was 3.3 days, and mean follow-up was 2.7 years.

Conclusion: This study describes the largest series of recurrent pituitary adenoma patients undergoing revision surgery to date. While the gross total resection rate may be lower than for primary surgery, revision endoscopic endonasal procedures are generally efficacious and safe with a low incidence of post-operative complications.



Publication History

Article published online:
01 February 2023

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