Endoscopic endonasal transsphenoidal surgery in recurrent and residual pituitary adenomas: Technical note

Despite a good cure rate after surgery, the recurrence rate in pituitary ad enomas is globally high. The decision making in such cases can be problemat ic for the nature of the lesion, for the anatomic structures involved, for the different pharmacological, surgical, radiotherapeutic and radiosurgical options nowadays available. In the perspective of an improvement and refin ement of the surgical procedure an endoscopic endonasal transsphenoidal app roach to the pituitary was recently adopted in the Neurosurgical Department of the University of Naples. Its minimal invasiveness and its wider and di rect anatomic control of the operative field has allowed a faster, greater and safer potential of tumour excision, with respect of the sphenoid, sella r and parasellar structures. The authors have examined the advantages provi ded by this technique in 12 patients with recurrent pituitary adenomas and in 2 craniopharyngiomas already treated via a transnasal transsphenoidal ap proach (TTA), where the anatomy of surgical field had been distorted by the first operation or the radiation therapy, They conclude that the endoscopi c transsphenoidal re-operation might be considered the procedure of choice in case of recurrences and its easiness in such conditions could favour its larger use, before other more aggressive therapeutic solutions.