2025 Proffered Presentations
S119: REVISION ENDOSCOPIC TRANSNASAL TRANSSPHENOIDAL SURGERY FOR RECURRENT PITUITARY ADENOMAS: RISK FACTORS AND CLINICAL OUTCOMES
Jessa E Miller, MD1; Kevin T Grafmiller, MD2; Nikitha Kosaraju, MD1; Myungjun Ko, MD1; Benjamin R Uy, MD, PhD1; Hye Rhyn Chung, MD1; Ryan M Shih, BS1; Shannon R Esswein, MD, PhD1; Won Kim, MD1; Jivianne T Lee, MD1; Marvin Bergsneider, MD1; Marilene B Wang, MD1; 1University of California, Los Angeles; 2North Shore Ear Nose and Throat
Introduction: Although the majority of patients who undergo endoscopic transnasal transsphenoidal (TNTS) surgery for pituitary adenomas have favorable outcomes, a small subset of patients require revision surgery due to recurrent tumors. The objective of this study was to identify risk factors for and outcomes following revision TNTS surgery for patients with recurrent pituitary adenomas.
Methods: A retrospective analysis was performed on all patients who underwent revision TNTS surgery for a recurrent pituitary adenoma from 2008 to 2024 at a tertiary skull base center. Patient demographics, radiologic features, intraoperative findings, and patient outcomes were collected.
Results: A total of 116 patients met inclusion criteria for the study. The mean age was 48.5 years and 50% were female. Thirteen patients (11.2%) had previously undergone radiation treatment. Seventy-eight patients (67.2%) had clinically non-functional tumors. Of the 38 functioning tumors, 15 (39.5%) were corticotrophic, 12 (31.6%) were somatotrophic, 10 (26.3%) were prolactinomas, and one (2.6%) was thyrotrophic. The mean tumor size was 21.1 millimeters (standard deviation=11.2). Preoperative imaging demonstrated cavernous sinus invasion in 73 patients (62.9%) and suprasellar extension in 56 patients (48.3%). The mean length of time from the prior surgery to revision surgery was 5.8 years (range=0-28 years). An intraoperative cerebrospinal fluid (CSF) leak was present in 60 patients (51.7%); 27 (23.3%), 29 (25.0%), and 4 (3.4%) had a grade 1, 2, and 3 leak, respectively. Twenty patients (17.2%) had a nasoseptal flap performed in a prior surgery that was re-used to reconstruct the sellar defect in the revision surgery. Of these 20 patients, one (5%) had a postoperative CSF leak. Eighty-two patients (70.7%) had a gross-total resection, one patient (0.9%) had a near-total resection (>95%), 21 patients (18.1%) had a partial resection, and the resection status was unknown in 12 patients (10.3%). Postoperatively, four patients (3.4%) developed meningitis, and five patients (4.3%) had a CSF leak.
Conclusion: Revision TNTS surgery for pituitary adenomas is necessary in a subset of individuals with recurrent tumors. Revision surgery is generally safe and efficacious; however, there are higher rates of intraoperative CSF leaks and lower rates of gross total resection among those undergoing revision surgery compared to previously published rates in non-revision cases. The nasoseptal flap is a robust reconstructive technique that can be taken down and re-used in revision surgery.