A total of 59 adult patients with a recurrent or regrowing pituitary adenoma underwent surgery using a pure endoscopic endonasal transsphenoidal approach. Of these patients, 31 were previously operated on by a microsurgical transsphenoidal approach, 22 by means of an endoscopic transsphenoidal route, and 6 via a transcranial route. The patient series has been divided into 3 tiers according to the primary surgery, and the results were evaluated accordingly.
Gross total removal was achieved in 37 of our cases (62.7 % ). According to prior surgery at primary disease, we found that in the subgroup of patients who underwent a microsurgical transsphenoidal approach we achieved gross total removal in 23 cases (74.2 % ; 23 of 31), whereas in the group of patients who underwent the endoscopic endonasal approach, gross total removal was attained respectively in 13 cases (59.1 % ; 13 of 22) and in only 1 case of those who underwent the transcranial approach (16.7 % ; 1 of 6). Postoperative complications included 1 case (1.7 % ) of cerebrospinal fluid leak and meningitis, and 1 with an hematoma in the tumor field (1.7 % ); both needed surgical reoperation.
The endoscopic endonasal approach is a safe and effective procedure for the management of recurrent and/or regrowing pituitary tumors previously treated by either a microsurgical or an endoscopic approach.